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Uncontrolled Donation after Circulatory Death Only Lung Program: An Urgent Opportunity

Uncontrolled donation after circulatory death (uDCD) represents a potential source of lungs, and since Steen’s 2001 landmark case in Sweden, lungs have been recovered from uDCD donors and transplanted to patients in other European countries (France, the Netherlands, Spain and Italy) with promising r...

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Autores principales: Lazzeri, Chiara, Bonizzoli, Manuela, Di Valvasone, Simona, Peris, Adriano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10607380/
https://www.ncbi.nlm.nih.gov/pubmed/37892627
http://dx.doi.org/10.3390/jcm12206492
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author Lazzeri, Chiara
Bonizzoli, Manuela
Di Valvasone, Simona
Peris, Adriano
author_facet Lazzeri, Chiara
Bonizzoli, Manuela
Di Valvasone, Simona
Peris, Adriano
author_sort Lazzeri, Chiara
collection PubMed
description Uncontrolled donation after circulatory death (uDCD) represents a potential source of lungs, and since Steen’s 2001 landmark case in Sweden, lungs have been recovered from uDCD donors and transplanted to patients in other European countries (France, the Netherlands, Spain and Italy) with promising results. Disparities still exist among European countries and among regions in Italy due to logistical and organizational factors. The present manuscript focuses on the clinical experiences pertaining to uDCD lungs in North America and European countries and on different lung maintenance methods. Existing experiences (and protocols) are not uniform, especially with respect to the type of lung maintenance, the definition of warm ischemic time (WIT) and, finally, the use of ex vivo perfusion (available in the last several years in most centers). In situ lung cooling may be superior to protective ventilation, but this process may be difficult to perform in the uDCD setting and is also time-consuming. On the other hand, the “protective ventilation technique” is simpler and feasible in every hospital. It may lead to a broader use of uDCD lung donors. To date, the results of lung transplants performed after protective ventilation as a preservation technique are scarce but promising. All the protocols comprise, among the inclusion criteria, a witnessed cardiac arrest. The detectable differences included preservation time (240 vs. 180 min) and donor age (<55 years in Spanish protocols and <65 years in Toronto protocols). Overall, independently of the differences in protocols, lungs from uDCD donors show promising results, and the possibility of optimizing ex vivo lung perfusion may broaden the use of these organs.
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spelling pubmed-106073802023-10-28 Uncontrolled Donation after Circulatory Death Only Lung Program: An Urgent Opportunity Lazzeri, Chiara Bonizzoli, Manuela Di Valvasone, Simona Peris, Adriano J Clin Med Review Uncontrolled donation after circulatory death (uDCD) represents a potential source of lungs, and since Steen’s 2001 landmark case in Sweden, lungs have been recovered from uDCD donors and transplanted to patients in other European countries (France, the Netherlands, Spain and Italy) with promising results. Disparities still exist among European countries and among regions in Italy due to logistical and organizational factors. The present manuscript focuses on the clinical experiences pertaining to uDCD lungs in North America and European countries and on different lung maintenance methods. Existing experiences (and protocols) are not uniform, especially with respect to the type of lung maintenance, the definition of warm ischemic time (WIT) and, finally, the use of ex vivo perfusion (available in the last several years in most centers). In situ lung cooling may be superior to protective ventilation, but this process may be difficult to perform in the uDCD setting and is also time-consuming. On the other hand, the “protective ventilation technique” is simpler and feasible in every hospital. It may lead to a broader use of uDCD lung donors. To date, the results of lung transplants performed after protective ventilation as a preservation technique are scarce but promising. All the protocols comprise, among the inclusion criteria, a witnessed cardiac arrest. The detectable differences included preservation time (240 vs. 180 min) and donor age (<55 years in Spanish protocols and <65 years in Toronto protocols). Overall, independently of the differences in protocols, lungs from uDCD donors show promising results, and the possibility of optimizing ex vivo lung perfusion may broaden the use of these organs. MDPI 2023-10-12 /pmc/articles/PMC10607380/ /pubmed/37892627 http://dx.doi.org/10.3390/jcm12206492 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Lazzeri, Chiara
Bonizzoli, Manuela
Di Valvasone, Simona
Peris, Adriano
Uncontrolled Donation after Circulatory Death Only Lung Program: An Urgent Opportunity
title Uncontrolled Donation after Circulatory Death Only Lung Program: An Urgent Opportunity
title_full Uncontrolled Donation after Circulatory Death Only Lung Program: An Urgent Opportunity
title_fullStr Uncontrolled Donation after Circulatory Death Only Lung Program: An Urgent Opportunity
title_full_unstemmed Uncontrolled Donation after Circulatory Death Only Lung Program: An Urgent Opportunity
title_short Uncontrolled Donation after Circulatory Death Only Lung Program: An Urgent Opportunity
title_sort uncontrolled donation after circulatory death only lung program: an urgent opportunity
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10607380/
https://www.ncbi.nlm.nih.gov/pubmed/37892627
http://dx.doi.org/10.3390/jcm12206492
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