Transplantation of lungs from non-heart-beating donors after functional assessment ex vivo.
BACKGROUND
If lungs from patients dying of heart attacks are to serve as donor organs in a safe way, their function should be properly assessed before transplantation. The aim of this study was to investigate donor lung function evaluation in a realistic large animal model.


METHODS
Twelve 60-kg pigs were used. Five minutes after ventricular fibrillation was induced, cardiopulmonary resuscitation was initiated and maintained for 20 minutes. After a 10-min hands-off period, heparin was administered through a central venous catheter followed by 20 chest compressions. Intrapleural cooling was initiated after 65 minutes of warm ischemia. Cooling proceeded for 6 hours within the cadaver, after which lung function was assessed ex vivo. Recipient pigs underwent left lung transplantation followed by right pneumonectomy, thus making these animals 100% dependent for their survival on the function of the donor lungs.


RESULTS
The assessment showed that all lungs had adequate function to serve as donor lungs. All recipient animals were in good condition during the 24-hour observation period after the operation. The blood gas function did not differ significantly from that in the healthy donor animals before induction of ventricular fibrillation; pulmonary vascular resistance was within normal range.


CONCLUSIONS
Lungs from non-heart-beating donors topically cooled in situ for 6 hours after 65 minutes of warm ischemia were assessed ex vivo and found to have normal function. They were then transplanted and retained normal function during a 24-hour observation period.
Steen
Stig
S
Department of Cardiothoracic Surgery, Heart-Lung Division, University Hospital of Lund, Lund, Sweden. stig-steen@thorax.lu.se
Liao
Qiuming
Q
Wierup
Per N
PN
Bolys
Ramunas
R
Pierre
Leif
L
Sjöberg
Trygve
T
D000818:Animals; D004195:Disease Models, Animal; D006084:Graft Rejection; D006085:Graft Survival; D006439:Hemodynamics / Q000502:physiology; D008170:Lung Compliance; D016040:Lung Transplantation / Q000379:methods*; D009926:Organ Preservation; D011237:Predictive Value of Tests; D011659:Pulmonary Gas Exchange; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013552:Swine; D014019:Tissue Donors; D014184:Transplantation, Homologous