Facilitating the improvement and enlargement of the donor pool in cardiothoracic transplantation

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    Abstract

    Heart and lung transplantation have become established treatment options
    for selected patients suffering from refractory end-stage heart and lung failure.
    However, the number of transplantations is limited due to the limited availability
    of suitable donor organs.
    In the cardiothoracic donor pool two subtypes of donation procedures are
    distinguished. One being donation after circulatory death (DCD) and the other
    being donation after brain death (DBD). With regards to organ preservation, the
    principal difference between a DCD and a DBD donor is that in the DBD donor
    both ventilation and blood circulation through organs are maintained up to the
    initiation of preservation of the organs. DBD organs are therefore not subjected to
    warm ischemic injury. In the DCD donor, the ventilation and blood circulation are
    already stopped prior to the initiation of preservation as a result of a withdrawal
    of life-sustaining therapy. With that, the organs are subjected to warm ischemia.
    The lungs are relatively tolerant to ischemia, whereas the heart is highly vulnerable
    to it. As a result of these characteristics, lungs and hearts encounter a different
    impact of a DBD or a DCD donation procedure. In turn, the technique used for
    preservation and the necessity to evaluate the organ ex situ after the donation
    procedure are dependent on both the donor organ and the donor type. Both ex
    vivo lung perfusion (EVLP) and ex situ heart perfusion (ESHP) play a key role in
    facilitating the enlargement and improvement of the donor pool, as a preservation
    technique, but also as a platform for functional assessment.
    The overall aim of this thesis was to explore and describe strategies to improve and
    enlarge the cardiothoracic donor pool. More specifically, the studies were designed
    to 1) describe and evaluate the implementation of both DCD lung transplantation
    and EVLP, 2) explore the potential of DCD heart donation for increasing the donor
    pool and 3) develop an ESHP strategy that facilitates preservation and assessment
    of donor hearts.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    Supervisors/Advisors
    • Mariani, Massimo, Supervisor
    • Rega, F, Supervisor, External person
    • Erasmus, Michiel, Co-supervisor
    Award date8-Sep-2021
    Place of Publication[Groningen]
    Publisher
    Print ISBNs978-94-6416-692-7
    DOIs
    Publication statusPublished - 2021

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