Official Sections CTRMS ISVCA IPITA IPTA ISODP IRTA IXA SPLIT TID

2013 - ISODP 2013 Congress


This page contains exclusive content for the member of the following sections: TTS, ISODP

Mini-Oral 1 on Donation

8.2 - Extended Criteria Donors (ECD) - xpanding the boundaries for Donation after Cardiac Death

Presenter: Nicola, Stitt, MELBOURNE, Australia
Authors: NICOLA STITT, DAVID PILCHER, TIM CROZIER

Extended Criteria Donors (ECD) – Expanding the boundaries for Donation after Cardiac Death

NICOLA STITT1,2, DAVID PILCHER2,3,4, TIM CROZIER1

1INTENSIVE CARE UNIT, MONASH HEALTH, MELBOURNE, Australia, 2DONATELIFE VICTORIA, MELBOURNE, Australia, 3DEPT OF INTENSIVE CARE, THE ALFRED HOSPITAL, MELBOURNE, Australia, 4DEPARTMENT OF EPIDEMIOLOGY AND PREVENTATIVE MEDICINE, MONASH UNIVERSITY, MELBOURNE, Australia

Introduction

The upper age limit for lung donation via the Donation after Cardiac Death (DCD) pathway has generally been considered to be 65 years. We report a case of a 73 year old patient who was able to donate his lungs for transplantation.

Case Description

A 73 yr old male ex-smoker was admitted to the Intensive Care Unit (ICU) following an out-of-hospital cardiac arrest due to myocardial infarction.  The likelihood of neurological recovery was poor and during end of life discussions the family raised the possibility of organ donation with the Intensivist. As he was unlikely to progress to brain death the only option was the DCD pathway. However current guidelines suggested that he was over the age limit for lungs, liver and kidney donation, with the previous oldest DCD lung donor being 65 years old.

Upon consideration the Intensivist engaged the help of the Nurse Donation Specialist who investigated the possibility of donation with Donatelife Victoria (DLV). The initial response received was that he was too old for DCD. The family were disappointed with this outcome. Further discussions between the Intensivist and Organ Donor Coordinator (ODC) at DLV led to another approach to the lung transplant team for reconsideration.

Arterial Blood Gas (ABG) on 100% oxygen. pH 7.35, pCO2 42.3, pO2 458, BE -2. Chest X- ray & bronchoscopy were clear. Ventilation requirements were FiO2 = 0.30, PEEP 10cm, PS 12.*

After reviewing the patients’ current condition it was decided that he would be accepted as potential lung donor.

Following withdrawal of life sustaining therapy the patient died peacefully within the timeframe required for DCD. This resulted in successful lung donation, with subsequent successful bilateral lung transplantation

Conclusion

Exploring the possibility of extended criteria donation in carefully selected patients may result in more organs being available for transplant.

 

*PEEP: Positive End Expiratory Pressure   PS: Pressure Support


Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.

Social

Contact

Staff Directory
+1-514-874-1717
This email address is being protected from spambots. You need JavaScript enabled to view it.

Address

The Transplantation Society
International Headquarters
505 Boulevard René-Lévesque Ouest
Suite 1401
Montréal, QC, H2Z 1Y7
Canada