Poster 01. Expanding the donor pool by extended DCD lung donation

Thursday 14 march 2019

12:30 - 12:33h

Categories: Nursing, Postersessie

Parallel session: Postersessies 1 - Nursing

E.M.M. Koffeman1, J.M. Droogh2, A. Veen1, M.E. Erasmus3, C.T. Gan4, H.A.M. Kerstjens4, M. Mariani3, E.A.M. Verschuuren4

1Dept. of Surgery,2Dept. of Critical Care, 3Dept. of Cardiothoracic Surgery,4Dept. of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, Groningen,The Netherlands.

Introduction: Almost half of the lung transplantations in the Netherlands are performed with donation after circulatory death (DCD) donors. However, over 25% of the DCD donations are cancelled because the agonal phase exceeds the current maximum length for donation: 120 minutes. Pig models testing lungs ex-vivo (EVLP) have shown that a prolonged agonal phase doesn’t compromise the quality of the lungs. Given the possibility to test lungs on the EVLP before transplantation the length of the agonal phase might be less important in DCD lung donation. In 2017 four suitable DCD lung donations out of 20 DCD procedures in our center were cancelled due to a prolonged agonal phase. In 2018 three out of 18 DCDs were cancelled so far. We therefore here present a protocol to accept DCD lung donation irrespective of length of the agonal phase.

Methods: Informed consent will be obtained from patients on the lung transplant waiting list from our center to receive extended DCD (eDCD) lungs. All suitable DCD lung donors from our center will be included. When a donor exceeds the 2 hour agonal phase limit for regular organ donation, the donor becomes an eDCD donor and donation then is limited to the lungs. When a donor passes, after five minutes ‘no touch’, the donor will be transported to the OR for intubation. Lungs will be inflated by CPAP until the thoracic surgeons are available for procurement. After opening of the chest the lungs will be ventilated according to Dutch DCD guidelines. All eDCD lungs will be evaluated during EVLP after procurement. When the lungs are suitable for transplantation after evaluation on the EVLP they will be transplanted in a recipient who gave consent to receive eDCD lungs.

Discussion: Currently, many potentially suitable lungs are not procured due to the prolonged agonal phase. It is going to be a logistic challenge to procure these lungs after a prolonged agonal phase. However, with the use of EVLP, lungs can be evaluated before transplantation and logistics can be managed. Therefore, we expect to increase the number of lung donations in our center with 3-5 per year by eDCD .