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Minerva Anestesiologica 2020 September;86(9):984-91

DOI: 10.23736/S0375-9393.20.14262-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Donation after circulatory death: possible strategies for in-situ organ preservation

Marinella ZANIERATO ¹ ✉, Daniele DONDOSSOLA ², Alessandro PALLESCHI ³, Alberto ZANELLA ^{4, 5}

¹ Department of Anesthesia, Intensive Care and Emergency, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy; ² Unit of Liver Transplant and General Surgery, Maggiore Polyclinic Hospital, IRCCS Ca’ Granda Foundation, Milan, Italy; ³ Unit of Thoracic Surgery and Lung Transplant, Maggiore Polyclinic Hospital, IRCCS Ca’ Granda Foundation, Milan, Italy; ⁴ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; ⁵ Department of Anesthesia, Critical Care and Emergency, Maggiore Polyclinic Hospital, IRCCS Ca’ Granda Foundation, Milan, Italy

Donation after circulatory death (DCD) is an accepted strategy to expand the potential donor pool. The complexity of organ procurement from DCD donors requires the development of new strategies for organ preservation. Standard DCD organ recovery involves a super rapid technique, with cold thoracic and abdominal perfusion. However, the conventional methods of preservation based on static and hypothermic storage may not be the most appropriate for DCD grafts, especially in the presence of long warm ischemia times. New strategies designed to improve the preservation of in-situ DCD grafts include the use of normothermic regional perfusion (NRP) for abdominal organs and concomitant cold lung flushing. The use of in-situ NRP is a significant advance in abdominal organ retrieval and it has the potential to increase organ recovery rates due to its applicability in both controlled and uncontrolled DCD donors. We describe an innovative preservation strategy based on the combination of donor NRP for abdominal organ preservation and a normothermic open-lung approach with protective mechanical ventilation for lung preservation.

KEY WORDS: Warm Ischemia; Reperfusion injury; Extracorporeal membrane oxygenation; Ventilation; Tissue and organ procurement; Liver transplantation