D. Van Raemdonck, G. M. Verleden, L. Dupont, D. Ysebaert, D. Monbaliu, A. Neyrinck, W. Coosemans, H. Decaluwe, P. De Leyn, P. Nafteux, T. Lerut
[Applied Cardiopulmonary Pathophysiology 15: 38-48, 2011]
Objectives: Donors after cardiac death (DCD) have increasingly provided organs for lung transplantation (LTx). The use of lungs from donors after euthanasia has not yet been reported.
Methods: Between 01/2007-12/2009, 17/145 (11.7%) isolated LTx were performed from controlled DCD, including 4 (2.8%) after euthanasia. All donors expressed their wish for organ donation once their request for euthanasia was granted according to Belgian legislation. All donors suffered from an unbearable non-malignant disorder.
Results: The warm ischemic time between circulatory arrest and cold flush of donor lungs was 14 [10-16] min. Total ischemic time until reperfusion of the graft was 329 [225-414] min for the first lung and 517 [346-547] min for the second lung. No severe graft dysfunction was observed beyond 24 hours. One recipient died in the ICU from a problem unrelated to the graft. The remaining patients were extubated after 2 [2-3] days and discharged from ICU after 7 [4-7] days and from hospital after 33 [23-36] days. FEV1 and FVC increased from 16 [15-21]% and 52 [51-59]% pre-transplant to 85 [61-94]% and 79 [63-84]% at the time of hospital discharge, respectively; (p<0.01). Actuarial 1-year and 3-year survival was 75%.
Conclusion: Euthanasia donors accounted for 23.5% of all DCD lung donors with excellent post-transplant graft function and good early recipient outcome.
Key words: lung transplantation, donation after cardiac death, donation after brain death, non-heart-beating donors, euthanasia, end-of-life
Prof. Dirk Van Raemdonck
Department of Thoracic Surgery
University Hospital Gasthuisberg