Organ donation and preservationPulmonary Recruitment Protocol For Organ Donors: A New Strategy to Improve the Rate of Lung Utilization
Section snippets
Lung Transplantation and Limited Donor Pool
The number of centers reporting lung transplantation had been relatively stable to 1997; however, annual activity has increased by 47% since 1999, with the number of procedures reaching a high of 2169 in 2005.1 Over the past decade, however, the number of patients on the waiting list has increased progressively and now far exceeds the number of available organs.1 In the United States, the number of candidates on the lung transplant waiting list increased by 11% from 1997 to 2006.2 Time on the
Pulmonary Recruitment Protocol
Our lung transplantation program was created in 1997. Since then, we have performed more than 300 lung transplantations. Our lung transplantation center is the only program serving the Province of Quebec, with 8 million inhabitants and a vast territory nearly 3 times the size of France or Texas. Québec-Transplant is the sole provincial organization responsible for coordinating organ donation, allocation, and procurement in Quebec (Fig. 1). Organs are allocated to transplant programs in Quebec
Results
Since 2001, the number of multiorgan donors in Quebec has varied from 127 in 2002 to a maximum of 151 in 2008 (Fig. 2). During the same period, the number of patients with end-stage lung disease awaiting transplantation increased from 53 to 82. However, despite the increased demand, the number of available organs and of lung transplantation procedures have not increased sufficiently to meet demand. Although 25 to 30 transplantation procedures were being performed annually, 6 to 16 patients died
Discussion
Over the years, organ donor availability has continued to be a serious problem in Quebec, with a relatively stable pool of potential suitable organs averaging 140 donors for about 8 million population. While the demand for transplantation in patients with end-stage lung disease has increased dramatically, the insufficient supply of donor lungs has resulted in prolonged time on the waiting list, with a substantial number of deaths. The demand for donor lungs clearly exceeds the availability in
Acknowledgments
We thank Michel Carrier, MD, Micheline Lyras, BSc N, Diane Gagnon, RN, and the entire staff from Québec Transplant for their continued support.
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Cited by (25)
Novel heat shock protein 90 inhibitor improves cardiac recovery in a rodent model of donation after circulatory death
2022, Journal of Thoracic and Cardiovascular SurgeryPhysiotherapy in Patients on the Organ Donation Pathway: A Survey of Current Practice
2021, Transplantation ProceedingsCitation Excerpt :A meta-analysis [15] found the use of protocols increases the number of lung transplants (odds ratio, 2.56 [1.41-4.62]; P = .002) and improved recipient survival at 30 days posttransplant (odds ratio, 2.37 [1.14-4.95]; P = .02). Although current lung management protocols include strategies that overlap with physiotherapy interventions (eg, positioning, recruitment maneuvers, ventilator or manual hyperinflation, and suctioning [16-19]), these protocols often do not specify physiotherapy, nor are they developed in consultation with physiotherapists, which may further contribute to a lack of engagement by physiotherapists in current protocols. The variability in the literature and limited evidence for physiotherapy are unlikely to be the only factors contributing to variations in physiotherapy practice in patients on the organ donation pathway.
Mechanical ventilation after lung transplantation
2016, Journal of Critical CareCitation Excerpt :Before organ retrieval for lung transplantation, ventilation with higher Vt is an independent risk factor for the development of lung injury in organ donors with brain injuries. Furthermore, protective ventilation strategies in donors (low Vt, appropriate PEEP, and alveolar recruitment maneuvers) may increase the number of transplantable organs [2,16,17]. There is strong experimental evidence showing that ventilation strategies influence the development of lung injury after ischemia and reperfusion.
Effect of an intensive lung donor-management protocol on lung transplantation outcomes
2014, Journal of Heart and Lung TransplantationCitation Excerpt :Furthermore, the rate of lung donors was 69% of all organ donors at or below the usual age limit for lung donation of 70 years. Such figures in lung donors greatly exceed the data presented in the most important publications on lung donor management6,16,17 and data published by the ONT,15, Eurotransplant,18 and the United Network for Organ Sharing.19 The comparison made between both study periods bears out our hypothesis that implementing an intensive lung donor-management protocol based on a very strict protocol would increase the lung procurement rate, given that the main difference in both periods was donor management with CVP, PEEP, and HRT.
Efficacy of recruitment maneuver for improving the brain dead marginal lungs to ideal
2013, Transplantation Proceedings
This study was supported by the Alfonso Minicozzi and Family Chair in Thoracic Surgery and Lung Transplantation, University of Montréal, Montréal, Québec, Canada.