Donation after circulatory death (DCD)—lung procurement

Abstract

The number of lungs available for lung transplantation is far lower than the number of patients awaiting them. Consequently, there is a significant attrition rate while awaiting transplantation. Lung procurement rates are lower than those of other solid organs. Lungs are procured from only 15–20% of donors compared with 30% of decreased donors for hearts. The reason for this low retrieval rate is related to a number of factors. Brain death is associated with neurogenic pulmonary edema. Additionally, injury to the lung itself may occur before or after brain death. Aspiration of gastric contents, pneumonia, previous thoracic trauma, ventilator-associated injury, atelectasis, and pulmonary thrombosis/embolism may all contribute to lung injury before consideration for harvest. Donation after circulatory death (DCD) is one category of nontraditional organ donation now being performed in increasing numbers as a way to increase the number of lungs available for transplantation. In some studies, estimates show that utilization of DCD lung procurement could increase the number of lungs available by up to 50%.

Mesenchymal Stromal/Stem Cells and Their Products as a Therapeutic Tool to Advance Lung Transplantation

“…This scenario is not only due to the shortage of available donors, but also to the low utilization rate of donor lungs. Indeed, it has been evaluated that a large number of multiorgan donors are not suitable for LTx [ 3 , 13 ] and, in particular for donation after circulatory death (DCD), lungs are considered eligible for transplantation in only 2% of cases [ 13 ]. Potentially suitable lungs are deemed ineligible for transplant due to various criteria, including the donor history, pneumonia, chest trauma, aspiration, purulent secretions, positive sputum gram stain, or inadequate gas exchanges [ 1 , 48 , 49 ].…”

“…Survival rates after LTx have improved, yet outcomes are still poorer than other solid organ transplants [ 3 , 6 ]. The advances of the lung preservation techniques and the better understanding of the main mechanisms governing IRI processes can lead to a significant reduction in the incidence of lung PGD [ 118 ].…”

“…Lung transplantation (LTx) has become the treatment of choice for patients with end-stage respiratory failure and, over the past decades, the worldwide survival of lung transplant patients has increased significantly [ 1 ]. Unfortunately, the short- and long-term outcomes of LTxs are still less favorable than other solid organ transplants, the main faults being organ shortage and the fact that more than 80% of potential organ donors are not suitable or used for transplantation [ 2 , 3 , 4 , 5 , 6 ]. Moreover, other factors, such as postoperative graft dysfunction (PGD), infections, and rejection may also contribute to post-transplant mortality [ 7 , 8 ].…”

“…Although the use of extended-criteria lung donors and donors after cardio-circulatory death is increasing, there is still wide consensus in the transplant community that a large proportion of potentially viable grafts is discarded due to fear of early graft dysfunction and the increased postoperative morbidity and mortality of the recipient [ 1 , 3 , 9 , 10 ]. Ischemia-reperfusion injury (IRI) is the leading cause of early postoperative lung dysfunction, and is characterized by alveolar damage and lung edema usually occurring within 72 hours after LTx [ 11 ].…”

Endothelin-Converting Enzyme 1 and Vascular Endothelial Growth Factor as Potential Biomarkers during Ex Vivo Lung Perfusion with Prolonged Hypothermic Lung-Sparing

“…Lung transplantation (LTx) is the last resort treatment for patients with severe chronic lung disease. Unfortunately, only approximately 15% of donor lungs are suitable for transplantation, the remainder being generally inadequate due to brain death-induced lung injury and ICU-related complications, resulting in endothelial dysfunction and edema formation [1]. Therefore, LTx requires optimal utilization of available donors and the optimization of donor's organ use.…”