Transplantation of a heart donated after circulatory death via thoraco-abdominal normothermic regional perfusion and results from the first Spanish case.

BACKGROUND: Controlled donation after circulatory death (cDCD) has emerged as one of the main strategies for increasing the organ donor pool. Because of the ischemic injury that follows the withdrawal of life-sustaining therapies, hearts from cDCD donors have not been considered for transplantation until recently. The ex-situ perfusion of hearts directly procured from cDCD donors has been used to allow the continuous perfusion of the organ and the assessment of myocardial viability prior to transplantation. Based on our experience with abdominal normothermic regional perfusion in cDCD, we designed a protocol to recover and validate hearts from cDCD donors using thoraco-abdominal normothermic regional perfusion without the utilization of an ex-situ device. CASE PRESENTATION: We describe the first case of a cDCD heart transplant performed with this approach in Spain. The donor was a 43-year-old asthmatic female diagnosed with severe hypoxic encephalopathy. She was considered a potential cDCD donor and a suitable candidate for multiorgan procurement including the heart via thoraco-abdominal normothermic regional perfusion. The heart recipient was a 60-year-old male diagnosed with amyloid cardiomyopathy. Cold ischemia time was 55 min. The surgery was uneventful. CONCLUSIONS: This case report, the first of its kind in Spain, supports the feasibility of evaluating and successfully transplanting cDCD hearts without the need for ex-situ perfusion based on the use of thoraco-abdominal normothermic regional perfusion opening the way for multiorgan donation in cDCD.

Implementation of a mobile team to provide normothermic regional perfusion in controlled donation after circulatory death: Pilot study and first results.

Normothermic regional perfusion (NRP) in controlled donation after circulatory death is becoming a popular method due to the favorable results of the grafts procured under this technique. This procedure requires experience, and, sometimes, the availability of extracorporeal membrane oxygenation (ECMO) machines to implement NRP is limited to tertiary hospitals. In order to provide support with NRP in controlled donation after circulatory death across the different hospitals of the Autonomous Community of Madrid, a mobile NRP team was created. In the first 18 months since its creation, the mobile NRP team participated in 33 procurements across nine different hospitals, representing 72% of all controlled donations after circulatory death in the Autonomous Community of Madrid. NRP was successfully performed in 29 (88%) cases, with a mean duration of 69 ± 27 minutes. A total of 39 kidneys, 12 livers, and 5 bilateral lungs were recovered and transplanted. None of the livers were discarded due to an elevation in transaminases during NRP. A mobile NRP team is a feasible option and, in our series, aided in the optimization and recovery of organs from donors after controlled circulatory death in centers where ECMO technology was not available.

Conviviendo con la incertidumbre: intervención psicológica en una mujer con un problema de adaptación en lista de espera para trasplante de pulmón / Living with uncertainty: Psychological intervention in a woman with an adjustment disorder waiting for a lung transplant

El Modelo Español de Trasplante es un referente mundial dada su óptima eficacia y eficiencia. Habitualmente el trasplante de órganos es la única opción para sobrevivir, convirtiendo a este proceso en un suceso vital estresante dividido en fases que deben irse afrontando. La fase de lista de espera suele asociarse a una mayor vulnerabilidad psicológica, debido a que ésta suele ser larga y constituye una amenaza real a la supervivencia, asociándose a una alta incertidumbre. Se presenta el caso de una mujer con un problema de adaptación con sintomatología mixta ansiosa y depresiva, asociado a la espera para un trasplante de pulmón. Tras la aplicación de un programa de tratamiento cognitivo-conductual dirigido al desarrollo de un afrontamiento más adaptativo, al manejo de la preocupación y a aprender a convivir con la incertidumbre, se observaron cambios clínicamente significativos en las variables implicadas, logros que se mantuvieron tras un mes de seguimiento

The Spanish Model of Transplantation has achieved global recognition, because of its efficacy and efficiency levels. Almost always, organ transplant is the person’s only chance of survival. So, organ transplantation could be considered a stage-process related to a stressful life event which individuals must cope with. The waiting list stage probably is associated to a higher psychological vulnerability, as it is usually a long process and a real risk to survival, characterized by high uncertainty. The case of a woman diagnosed with an adjustment disorder with mixed anxiety and depressed mood associated with being on a waiting list for two years is presented. A cognitive-behavioral intervention was applied to develop more adaptive coping-skills, to manage rumination, and to learn to live with uncertainty. Results showed significant clinical outcomes in those mechanisms and also in anxiety and depression levels. These changes were maintained in the follow-up stage, one month later