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Review
. 2024 May 1:37:12659.
doi: 10.3389/ti.2024.12659. eCollection 2024.

Lung Transplantation in Controlled Donation after Circulatory-Determination-of-Death Using Normothermic Abdominal Perfusion

Paula Moreno  1   2 , Javier González-García  1   2 , Eloísa Ruíz-López  1   2 , Antonio Alvarez  1   2
Affiliations
Review

Lung Transplantation in Controlled Donation after Circulatory-Determination-of-Death Using Normothermic Abdominal Perfusion

Paula Moreno et al. Transpl Int. .

Abstract

The main limitation to increased rates of lung transplantation (LT) continues to be the availability of suitable donors. At present, the largest source of lung allografts is still donation after the neurologic determination of death (brain-death donors, DBD). However, only 20% of these donors provide acceptable lung allografts for transplantation. One of the proposed strategies to increase the lung donor pool is the use of donors after circulatory-determination-of-death (DCD), which has the potential to significantly alleviate the shortage of transplantable lungs. According to the Maastricht classification, there are five types of DCD donors. The first two categories are uncontrolled DCD donors (uDCD); the other three are controlled DCD donors (cDCD). Clinical experience with uncontrolled DCD donors is scarce and remains limited to small case series. Controlled DCD donation, meanwhile, is the most accepted type of DCD donation for lungs. Although the DCD donor pool has significantly increased, it is still underutilized worldwide. To achieve a high retrieval rate, experience with DCD donation, adequate management of the potential DCD donor at the intensive care unit (ICU), and expertise in combined organ procurement are critical. This review presents a concise update of lung donation after circulatory-determination-of-death and includes a step-by-step protocol of lung procurement using abdominal normothermic regional perfusion.

Keywords: DCD donors; donation after circulatory determination-of-death; lung procurement; lung transplantation; normothermic regional perfusion.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Schematic presentation of time points and intervals as suggested by the ISHLT DCD Working Group.
FIGURE 2
FIGURE 2
Step by step schematic presentation of DCD organ procurement under NRP. WLST, Withdrawal life sustaining therapies; NRP, normothermic regional perfusion. ECMO, extracorporeal membrane oxygenation; PA, pulmonary artery; SVC, superior vena cava; IVC, inferior vena cava. FiO2, Fraction of inspired oxygen; PEEP, Positive end expiratory pressure.
See this image and copyright information in PMC

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