Maintaining the permanence principle for death during in situ normothermic regional perfusion for donation after circulatory death organ recovery: A United Kingdom and Canadian proposal

Alex Manara, Sam D. Shemie, Stephen Large, Andrew Healey, Andrew Baker, Mitesh Badiwala, Marius Berman, Andrew J. Butler, Prosanto Chaudhury, John Dark, John Forsythe, Darren H. Freed, Dale Gardiner, Dan Harvey, Laura Hornby, Janet MacLean, Simon Messer, Gabriel C. Oniscu, Christy Simpson, Jeanne TeitelbaumSylvia Torrance, Lindsay C. Wilson, Christopher J.E. Watson

Résultat de recherche: Articleexamen par les pairs

135 Citations (Scopus)

Résumé

There is international variability in the determination of death. Death in donation after circulatory death (DCD) can be defined by the permanent cessation of brain circulation. Post-mortem interventions that restore brain perfusion should be prohibited as they invalidate the diagnosis of death. Retrieval teams should develop protocols that ensure the continued absence of brain perfusion during DCD organ recovery. In situ normothermic regional perfusion (NRP) or restarting the heart in the donor's body may interrupt the permanent cessation of brain perfusion because, theoretically, collateral circulations may restore it. We propose refinements to current protocols to monitor and exclude brain reperfusion during in situ NRP. In abdominal NRP, complete occlusion of the descending aorta prevents brain perfusion in most cases. Inserting a cannula in the ascending aorta identifies inadequate occlusion of the descending aorta or any collateral flow and diverts flow away from the brain. In thoracoabdominal NRP opening the aortic arch vessels to atmosphere allows collateral flow to be diverted away from the brain, maintaining the permanence standard for death and respecting the dead donor rule. We propose that these hypotheses are correct when using techniques that simultaneously occlude the descending aorta and open the aortic arch vessels to atmosphere.

Langue d'origineEnglish
Pages (de-à)2017-2025
Nombre de pages9
JournalAmerican Journal of Transplantation
Volume20
Numéro de publication8
DOI
Statut de publicationPublished - août 1 2020

Note bibliographique

Funding Information:
The study was funded in part by the National Health Service Blood and Transplant (NHSBT) Organ Donation and Transplant Directorate and the National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation at the University of Cambridge in collaboration with Newcastle University and in partnership with NHSBT. The views expressed are those of the authors and not necessarily those of the National Health Service, NHSBT, the NIHR or the UK Department of Health, or Canadian Blood Services.

Funding Information:
The study was funded in part by the National Health Service Blood and Transplant (NHSBT) Organ Donation and Transplant Directorate and the National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation at the University of Cambridge in collaboration with Newcastle University and in partnership with NHSBT. The views expressed are those of the authors and not necessarily those of the National Health Service, NHSBT, the NIHR or the UK Department of Health, or Canadian Blood Services.

Publisher Copyright:
© 2020 The Authors. American Journal of Transplantation published by Wiley Periodicals, Inc. on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons

ASJC Scopus Subject Areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

Empreinte numérique

Plonger dans les sujets de recherche 'Maintaining the permanence principle for death during in situ normothermic regional perfusion for donation after circulatory death organ recovery: A United Kingdom and Canadian proposal'. Ensemble, ils forment une empreinte numérique unique.

Citer