A 360° Rotational Positioning Protocol of Organ Donors May Increase Lungs Available for Transplantation*

Abstract

Objectives: To evaluate the improvement in lung donation and immediate lung function after the implementation of a 360° rotational positioning protocol within an organ procurement organization in the Midwest. Design: Retrospective observational study. Setting: The Midwest Transplant Network from 2005 to 2017. Rotational positioning of donors began in 2008. Subjects: Potential deceased lung donors. Interventions: A 360° rotational protocol. Presence of immediate lung function in recipients, change in Pao 2:Fio 2 ratio during donor management, initial and final Pao 2:Fio 2 ratio, and proportion of lungs donated were measured. Outcomes were compared between rotated and nonrotated donors. Measurements and Main Results: A total of 693 donors were analyzed. The proportion of lung donations increased by 10%. The difference between initial Pao 2:Fio 2 ratio and final Pao 2:Fio 2 ratio was significantly different between rotated and nonrotated donors (36 ± 116 vs 104 ± 148; p < 0.001). Lungs transplanted from rotated donors had better immediate function than those from nonrotated donors (99.5% vs 68%; p < 0.001). Conclusions: There was a statistically significant increase in lung donations after implementing rotational positioning of deceased donors. Rotational positioning significantly increased the average difference in Pao 2:Fio 2 ratios. There was also superior lung function in the rotated group. The authors recommend that organ procurement organizations consider adopting a rotational positioning protocol for donors to increase the lungs available for transplantation.

Successful lung transplantation after prone positioning in an ineligible donor: a case report

“…It returned to a viable state after the donor was in the prone position for 12 h. Traditionally, the prone position has been used for acute respiratory distress syndrome [ 12 ]. It allows the alveoli to open and participate in gas exchange, which increases PaO 2 [ 8 ]. Recently, Marklin et al suggested the effect of prone positioning in BD donors.…”

“…The reaction to prone positioning started to occur after four hours, and a significant improvement in oxygenation was observed after 12 h, as seen in this case [ 7 ]. The improved oxygenation due to prone positioning is likely mediated by rapid positional improvements in the V/Q mismatch, enhanced postural drainage of secretions, and sustained improvements in atelectasis and shunting [ 7 , 8 , 12 ]. In this case, we confirmed the reversal of the non-aerated region with EIT instead of CT. As EIT is a non-invasive monitoring method that makes cross-sectional images of the chest through the analysis of transthoracic electrical conductivity, this technique is radiation-free and applicable at the bedside.…”

“…However, with proper supportive padding, these donors have better oxygenation in the supported prone position, as mediastinal contents fall anteriorly facilitating ventilation. In a previous study, the only adverse event related to the prone position was arterial line dislodgment; there were no inadvertent extubations [ 8 ]. In our case, no complications occurred.…”

“…The mortality on the waiting list has been high because of the imbalance between the number of available organs and potential recipients [ 3 ]. Therefore, it is necessary to increase the number of available lungs for transplantation through active lung management of marginal or unacceptable donors [ 8 ]. Although prone positioning has been widely accepted in the intensive care unit for refractory hypoxemia, it is still a novel treatment in lung donor management.…”

“…However, in BD donors, if there is severe hemodynamic instability or a possibility that the organ to be transplanted can be damaged by abdominal wounds or multiple trauma, the prone position is not suitable. A careful approach is required depending on the donor's condition [8]. Atelectasis is a correctable problem that is common among donors.…”