Organ donation and transplantation after cardiac death PDF
Preview Organ donation and transplantation after cardiac death
Organ Donation and Transplantation after Cardiac Death This page intentionally left blank Organ Donation and Transplantation after Cardiac Death Edited by David Talbot Anthony M. D’Alessandro Assistant Editor Paolo Muiesan 1 1 Great Clarendon Street,Oxford OX2 6DP Oxford University Press is a department ofthe University ofOxford. It furthers the University’s objective ofexcellence in research,scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark ofOxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc.,New York © Oxford University Press 2009 The moral rights ofthe author have been asserted Database right Oxford University Press (maker) First published 2009 All rights reserved.No part ofthis publication may be reproduced, stored in a retrieval system,or transmitted,in any form or by any means, without the prior permission in writing ofOxford University Press, or as expressly permitted by law,or under terms agreed with the appropriate reprographics rights organization.Enquiries concerning reproduction outside the scope ofthe above should be sent to the Rights Department, Oxford University Press,at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library ofCongress Cataloguing in Publication Data Data available Typeset by Cepha Imaging Private Ltd.,Bangalore,India Printed and bound in Great Britain by Biddles Ltd.,King’s Lynn ISBN 978–0–19–921733–5 Oxford University Press makes no representation,express or implied,that the drug dosages in this book are correct.Readers must therefore always check the product information and clinical procedure with the most up to date published product information and data sheets provided by the manufactures and the most recent codes ofconduct and safety regulations.The authors and publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication ofmaterial in this work.Except where otherwise stated,drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding. Foreword In 1999 Paul Terasaki wrote an editorial on non-heart-beating (NHB) donation in clinical transplantation.He stated that NHB donation had the potential to eradicate the shortage ofkidneys that had frustrated the transplant community ever since the early days.How close was Paul at that date and has NHB donation done what he expected? This book,an initiative oftwo early believers in and supporters ofNHB donation, depicts the wording ofthis special source oforgans for transplantation and presents the current situation,not only for kidneys,but for other organs as well. The book is rich in information on physiology ofischemia,and preservation both in general and specific for NHB organs.Viability testing has become crucial in NHB donation and the chapter by David Talbot is leading in this respect.It starts with the intriguing statement that NHB kidneys might actually be in a better condition then HB kidneys! Advanced procedures used to improve the preservation oforgans ‘touched’by warm ischemia are presented by experts in the field over several chapters. What makes this book so exceedingly interesting is the fact that the chapters are written by authors ofdifferent disciplines—for example,an ethicist and a paedi- atric intensive care specialist write together on the legal and moral issues ofNHB donation. The chapters on the European,the USA,and the Japanese settings are very inform- ative and illustrate a certain diversity,but also that the number ofavailable organs in all settings has increased! NHB and DCD are used interchangeably without confusion. I am convinced that this book will receive a welcome in the transplantation world as it presents a unique opportunity to increase the availability oforgans for our patients. Gauke Kootstra, Maastricht. This page intentionally left blank Preface Transplantation has been one ofthe most significant advances in health care over the last 40 years.This success has resulted in a marked increase in the numbers ofpatients who can benefit from transplantation as indicated by the ever increasing size ofwait- ing lists throughout the world.While there has been a modest increase in the number oforgan donors worldwide the disparity between the number ofpotential recipients and the number ofdeceased donors remains significant.Transplant practitioners have therefore searched for alternative sources ofdeceased donors including expanding the criteria for brain dead donors as well as returning to cardiac death donors,which formed the foundation oftransplantation before the establishment ofbrain death criteria.As there have been a number ofimprovements in surgical recovery,organ preservation,immunosuppression and post trasplant patient management,donation after cardiac death and transplantation has become one way to provide more recipients the opportunity to experience the benefits oftransplantation. Recovery oforgans from cardiac death donors requires the cessation ofcardio- circulatory function,a stand-offperiod followed by declaration ofdeath before organs can be recovered.After the heart has stopped beating all organs that depend upon oxygenated blood begin to deteriorate very rapidly.Using organs for transplantation after such damage carries a risk that they may never work after they are reperfused in the recipient.A number oftechniques have been developed to allow transplantation from cardiac death donors to be done successfully.This book has been written by internationally renowned experts in order to share this knowledge in a rapidly evolving field. While there are many practicalities oftransplanting such donor organs there are also many ethical issues which relate largely to the issues oforgan donation in a non brain dead patient such as: when does death actually occur? This book also covers these topics. David Talbot Anthony D’Alessandro This page intentionally left blank Contents Contributors xi 1 History ofnon-heart-beating donation 1 Gauke Kootstra 2 Legal,moral,and ethical issues 7 Sam D.Shemie,Michael De Vita 3 History oforgan perfusion in organ transplantation 31 Diethard Monbaliu,Qiang Liu,Katrien Vekemans,Jacques Pirenne 4 Viability testing ofkidneys from non-heart-beating donors 51 David Talbot 5 Perfusate development for the NHBD 67 Colin Wilson 6 Thrombolysis in the non-heart-beating donor 103 David Talbot,Mohamed Gok,Thomas Minor 7 Supplemental cryopreservation ofthe donor by peritoneal cooling 117 John Asher,Alex Navarro 8 Gaseous oxygen to improve viability ofmarginal or pre-damaged organ grafts during hypothermic storage 131 Thomas Minor 9 Extracorporeal circulatory-assisted non-heart-beating organ donation 153 JeffPunch 10 Patient selection and management 161 Julio Pascual,John D.Pirsch 11 The renal biopsy in non-heart-beating organ transplantation 173 M Snoeijs,R.Matthijsen,M.H.Christiaans,J.P.van Hooff,E.van Heurn, W.Buurman,R.J.van Suylen,C.J.Peutz-Kootstra 12 Early results for renal transplants from non-heart-beating donors 203 Alex Navarro 13 Liver transplantation using non-heart-beating donors 213 Paolo Muiesan
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