Initial Lung Transplantation Experience with Uncontrolled Donation after Cardiac Death in North America
Andrew Healey , Yui Watanabe . Caitlin Mills . Michele Stoncius , Susan Lavery , Karen Johnson , Robert Sanderson , Atul Humar , Jonathan Yeung , Laura Donahoe , Andrew Pierre , Marc de Perrot , Kazuhiro Yasufuku , Thomas K. Waddell , Shaf Keshavjee , Marcelo Cypel (Toronto)
Amer. J Transplant 2020 Jan https://doi.org/10.1111/ajt.15795
Uncontrolled donation after cardiac death (uDCD) has the potential to ameliorate the shortage of suitable lungs for transplantation. To date, no lung transplantation data from these donors is available from North America. Herein we describe the successful use of these donors using a simple method of in situ lung inflation so that the organ can be protected from warm ischemic injury. Forty‐four potential donors were approached, and family consent was obtained in 30 cases (68%). Of these, the lung transplant team evaluated 16 uDCDs on site, and 14 were considered for transplantation pending ex vivo lung perfusion (EVLP) assessment. Five lungs were ultimately used for transplantation (16.7% use rate from consented donors). The mean warm ischemic time was 2.8 hours. No primary graft dysfunction (PGD) grade 3 was observed at 24, 48 or 72 hours after transplant. Median ICU stay was 5 days (range: 2‐78 days) and median hospital stay was 17 days (range: 8‐100 days). The 30‐day mortality was 0%. Four out of five patients are alive at a median of 651 days (range: 121‐1254 days) with preserved lung function. This study demonstrates the proof of concept and the potential for uDCD lung donation using a simple donor intervention.