Lung Transplantation From Non Heart Beating Donors Without Pre-treatment

To increase the numbers of lung transplants, and possibly reduce effects of brain stem death, we commenced transplants from Non-heart-beating donors (NHBD)in 2002. Previous work had suggested the inflated lung was resistant to ischemia after death. All donors died after elective withdrawal of treatment (Maastrict III) and no pre-treatment was permitted. Lungs were inflated after bronchial toilet and assessed at sternotomy. Thrombus, if present, was removed from PA, followed by ante grade and retrograde pulmoplegia. Implantation and postoperative management was as our standard protocol. Data was collected prospectively. Since 2002, there were 8 recipients, 4 cystic fibrosis, 2 COPD and 2 fibrosing alveolitis, mean age 45, (range 19 to 64.4) Donors, mean age 30.75 years(range 15-47) died of cerebral trauma in 3, miscellaneous causes in 5. Mean time to asystole after withdrawal of treatment was 27.5 min(range 8-84).Mean inflated warm ischemic time was 29.12 min(range 9-95);with mean total warm ischemic time of 51.12 min(range 26-114). Total ischemic time was 348.37 min(range 297-413). Early function was excellent in 7 patients. 1 died on 8th POD with primary graft failure, 1 died on 47th POD of colonic perforation but good early graft function and 1 died at 4 months related to non-compliance. 5 surviving patients have excellent lung function and quality of life. These excellent early results demonstrate the safety of NHBD lung transplantation in the absence of any donor pre-treatment. Simple inflation of lungs gives adequate protection against warm ischemia for up to an hour.