Evaluation of functional warm ischemia time during controlled donation after circulatory determination of death using normothermic regional perfusion (ECMO‐TT): A prospective multicenter cohort study

Background Controlled donation after circulatory determination of death (cDCD) seems an effective way to mitigate the critical shortage of available organs for transplant worldwide. As a recently developed procedure for organ retrieval, some questions remain unsolved such as the uncertainty regardin...

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Published in:Artificial organs 2023-08, Vol.47 (8), p.1371-1385
Main Authors: Martínez‐Castro, Sara, Navarro, Rosalía, García‐Pérez, María Luisa, Segura, José Manuel, Carbonell, José A., Hornero, Fernando, Guijarro, Jorge, Zaplana, Marta, Bruño, María Ángeles, Tur, Ana, Martínez‐León, Juan Bautista, Zaragoza, Rafael, Núñez, Julio, Domínguez‐Gil, Beatriz, Badenes, Rafael, Monleón, Berta, Guillen, Antonio, Téllez, Alejandro, Bahamonde, Jose A, Gracia, Juan Manuel, Domenech, Alberto, Rengel‐Ruiz, Marcelo, Schröer, Volker, Casula, Elisabetta, Sanchis, Juan Manuel, Sala‐Almonacil, Vicente A., Altable, Mario, Esteller, Joan, Palau, Rocío, Alabau, José, Guevara, Audelio
Format: Article
Language:English
Subjects:
Blood & organ donations
Cohort analysis
controlled donation after circulatory determination of death
Encephalopathy
extracorporeal membrane oxygenation
Ischemia
Kidneys
Liver
normothermic regional perfusion
Organ donors
organ transplantation
Organs
Pancreas
Perfusion
Retrieval
Statistical analysis
withdrawal of life‐sustaining therapy
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Summary:Background Controlled donation after circulatory determination of death (cDCD) seems an effective way to mitigate the critical shortage of available organs for transplant worldwide. As a recently developed procedure for organ retrieval, some questions remain unsolved such as the uncertainty regarding the effect of functional warm ischemia time (FWIT) on organs´ viability. Methods We developed a multicenter prospective cohort study collecting all data from evaluated organs during cDCD from 2017 to 2020. All the procedures related to cDCD were performed with normothermic regional perfusion. The analysis included organ retrieval as endpoint and FWIT as exposure of interest. The effect of FWIT on the likelihood for organ retrieval was evaluated with Relative distribution analysis. Results A total amount of 507 organs´ related information was analyzed from 95 organ donors. Median donor age was 62 years, and 63% of donors were male. Stroke was the most common diagnosis before withdrawal of life‐sustaining therapy (61%), followed by anoxic encephalopathy (21%). This analysis showed that length of FWIT was inversely associated with organ retrieval rates for liver, kidneys, and pancreas. No statistically significant association was found for lungs. Conclusions Results showed an inverse association between functional warm ischemia time (FWIT) and retrieval rate. We also have postulated optimal FWIT's thresholds for organ retrieval. FWIT for liver retrieval remained between 6 and less than 11 min and in case of kidneys and pancreas, the optimal FWIT for retrieval was 6 to 12 min. These results could be valuable to improve organ utilization and for future analysis. Multicenter prospective cohort study collecting all data from evaluated organs during controlled Donor Cardiac Death. A total amount of 507 organs´ related information was analyzed from 95 organ donors. Optimal Functional Warm Ischemia Time's (FWIT) thresholds for organ retrieval remained between 6 and less than 11 min for liver and in case of kidneys and pancreas, the optimal FWIT for retrieval was 6 to 12 min.
ISSN:0160-564X
1525-1594
DOI:10.1111/aor.14539