Expanding the donor lung pool: how many donations after circulatory death organs are we missing?

BACKGROUND: The number of patients with end-stage pulmonary disease awaiting lung transplantation is at an all-time high, while the supply of available organs remains stagnant. Utilizing donation after circulatory death (DCD) donors may help to address the supply-demand mismatch. The objective of this study is to determine the potential donor pool expansion with increased procurement of DCD organs from patients who die at hospitals. MATERIAL AND METHODS: The charts of all patients who died at a single, rural, quaternary-care institution between August 2014 and June 2015 were reviewed for lung transplant candidacy. Inclusion criteria were age <65 y, absence of cancer and lung pathology, and cause of death other than respiratory or sepsis. RESULTS: A total of 857 patients died within a 1-year period and were stratified by age: pediatric <15 y (n = 32, 4%), young 15-64 y (n = 328, 38%), and old >65 y (n = 497, 58%). Those without cancer totaled 778 (90.8%) and 512 (59%) did not have lung pathology. This leaves 85 patients qualifying for DCD lung donation (pediatric n = 10, young n = 75, and old n = 0). Potential donors were significantly more likely to have clear chest X-rays (24.3% versus 10.0%, P < 0.0001) and higher mean PaO2/FiO2 (342.1 versus 197.9, P < 0.0001) compared with ineligible patients. CONCLUSIONS: A significant number of DCD lungs are available every year from patients who die within hospitals. We estimate the use of suitable DCD lungs could potentially result in a significant increase in the number of lungs available for transplantation.

How I Do It: Temporary RVAD Placed at the Time of Implantation of a HeartMate II LVAD.

Left ventricular assist devices (LVAD) are increasingly used to support patients as they await heart transplantation and as destination therapy for patients with end-stage cardiac failure. While the methods of LVAD implantation have become fairly standardized, early postoperative management of patients receiving these devices remains challenging. One issue that has plagued surgeons, cardiologists, and intensivists caring for patients after LVAD implantation is right heart dysfunction. While many scoring systems have been developed to try to anticipate RV failure, the accuracy of these predictive tools remains low. We present a novel approach of implantation of a temporary right ventricular assist devices (RVAD) during LVAD implantation with subsequent weaning in the immediate postoperative period, utilizing a strategy that does not require a return to the operating room for removal of the RVAD cannulas.