Donor prone positioning protects lungs from injury during warm ischemia

Watanabe Y1,2, Galasso M1, Watanabe T1, Ali A1, Qaqish R1, Nakajima D1, Taniguchi Y1, Pipkin M1, Caldarone L1, Chen M1, Kanou T1, Summers C1, Ramadan K1, Zhang Y1, Chan H3, Waddell TK1,2, Liu M1, Keshavjee S1,2, Del Sorbo L4, Cypel M1,2.  (Toronto)

Am J Transplant. 2019 Mar 19. doi: 10.1111/ajt.15363. [Epub ahead of print]

A large proportion of controlled donation after circulatory death (cDCD) donor lungs are declined because cardiac arrest does not occur within a suitable time after the withdrawal of life-sustaining therapy. Improved strategies to preserve lungs after asystole may allow the recovery team to arrive after death actually occurs and enable the recovery of lungs from more cDCD donors. The aim of this study was to determine the effect of donor positioning on the quality of lung preservation after cardiac arrest in a cDCD model. Cardiac arrest was induced by withdrawal of ventilation under anesthesia in pigs. After asystole, animals were divided into 2 groups based on body positioning (supine or prone). All animals were subjected to 3 hours of warm ischemia. After the observation period, donor lungs were explanted and preserved at 4°C for 6 hours, followed by 6 hours of physiologic and biological lung assessment under normothermic ex vivo lung perfusion. Donor lungs from the prone group displayed significantly greater quality as reflected by better function during ex vivo lung perfusion, less edema formation, less cell death, and decreased inflammation compared with the supine group. A simple maneuver of donor prone positioning after cardiac arrest significantly improves lung graft preservation and function.

© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.      KEYWORDS: animal models: porcine; basic (laboratory) research/science; donors and donation: donation after circulatory death (DCD); donors and donation: extended criteria; lung transplantation/pulmonology; organ perfusion and preservation; organ procurement; organ procurement and allocation; translational research/science 
PMID: 30887696 DOI: