Non–Heart-Beating Donors: An Excellent Choice to Increase the Donor Pool

Núñez, José R.; Río, Francisco del; López, Éder Iván Zamarrón; Moreno, Mauricio; Soria, Ana; Parra, David

doi:10.1016/j.transproceed.2005.09.105

Cited by 30 publications

(20 citation statements)

References 7 publications

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“…Importantly, during normothermic perfusion, there is evidence that -at least for the kidney -cytoprotective proteins such as heme oxygenase-1 can be upregulated [57], tissue repair can be stimulated [58] and that immunomodulation therapy can be used [59]. For uncontrolled DCD donors, the Spanish groups diagnose death after unsuccessful resuscitation outside the hospital but cardio-pulmonary 'resuscitation' is continued until the body is transferred to hospital [60]. As described by Fondevilla et al [53] on admission a femoral vessel cut down is performed and ECMO is commenced with an occlusive balloon placed in the aorta at the level of the diaphragm via the opposite femoral artery.…”

Section: Normothermic Liver Perfusion Utilising Extra-corporeal Membrmentioning

confidence: 99%

Liver transplantation using Donation after Cardiac Death donors

Monbaliu

Pirenne

Talbot

2012

Journal of Hepatology

180

121

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The success of solid organ transplantation has brought about burgeoning waiting lists with insufficient donation rates and substantial waiting list mortality. All countries have strived to expand donor numbers beyond the standard Donation after Brain Death (DBD). This has lead to the utilization of Donation after Cardiac Death (DCD) donors, also frequently referred to as Non-Heart Beating Donors (NHBD). Organs from these donors inevitably sustain warm ischaemic damage which varies in its extent and affects early graft function as well as graft survival. As a consequence, 'non-vital' organs such as renal transplants have increased rapidly from DCD donors but more 'vital' organ transplants such as the liver have lagged behind. However, an increasing proportion of liver transplants are now derived from DCD donors. This article covers this expansion, current results, pitfalls, and steps taken to minimize complications and to improve outcome, and future developments that are likely to occur.

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Section: Normothermic Liver Perfusion Utilising Extra-corporeal Membrmentioning

confidence: 99%

Liver transplantation using Donation after Cardiac Death donors

Monbaliu

Pirenne

Talbot

2012

Journal of Hepatology

180

121

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“…Under these circumstances, liver grafts unavoidably encounter a period of warm ischemia injury and undergo further injuries in preservation and reperfusion process [1][2][3] . Poor quality of liver grafts is considered an important risk factor greatly reducing the liver transplantation effectiveness [4][5][6] . Clinical practice suggests that the warm ischemia time (WIT) should not be longer than 5 min [7] , and 10 min of WIT may be the upper limit.…”

Section: Introductionmentioning

confidence: 99%

Dynamical changing patterns of histological structure and ultrastructure of liver graft undergoing warm ischemia injury from non-heart-beating donor in rats

Ma¹,

Wang²,

Wu³

et al. 2006

WJG

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AIM:To investigate the histological and ultra-structural characteristics of liver graft during different of warm ischemia time (WIT) in rats and to predict the maximum limitation of liver graft to warm ischemia. METHODS:The rats were randomized into 7 groups undergoing warm ischemia injury for 0, 10, 15, 20, 30, 45 and 60 min, respectively. All specimens having undergone warm ischemia injury were investigated dynamically by light and electron microscopy, and histochemistry staining. After orthotopic liver transplantation (OLT)，the recovery of morphology of liver grafts after 6, 24 and 48 h was observed. RESULTS:The donor liver from non-heart-beating donors (NHBD) underwent ischemia injury both in the warm ischemia period and in the reperfusion period. Morphological changes were positively related to warm ischemia injury in a time-dependent manner during the reperfusion period. The results demonstrated that different degrees of histocyte degeneration were observed when WIT was within 30 min, and became more severe with the prolongation of WIT, no obvious hepatocyte necrosis was noted in any specimen. In the group undergoing warm ischemia injury for 45 min, small focal necrosis occurred in the central area of hepatic lobule first. In the group undergoing warm ischemia injury for 60 min, patchy or diffused necrosis was observed and the area was gradually extended, while hepatic sinusoid endothelial cells were obviously swollen. Hepatic sinusoid was obstructed and microcirculation was in disorder. CONCLUSION:The rat liver graft undergoing warm ischemia injury is in the reversible stage when the WIT is within 30 min. The 45 min WIT may be a critical point of rat liver graft to endure warm ischemia injury. When the WIT is over 60 min, the damage is irreversible.

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“…Limitation of LST is currently considered part of good clinical practice [8]. This type of donor should provide organs in better condition than noncontrolled donors [9]. However, some authors believe that donation following removal of limitation of LST reduces the availability of other organs that would be viable in a conventional donor [10].…”

Section: Discussionmentioning

confidence: 99%