Lung Transplantation from Non Heart Beating Donors without Pretreatment

Objectives: 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 ischaemia after death. Methods: All donors died after elective withdrawal of treatment (Maastricht III) and no pretreatment was permitted. Lungs were inflated after bronchial toilet and assessed at sternotomy. Thrombus, if present, was removed from PA, followed by antegrade and retrograde pulmoplegia. Implantation and postoperative management was as our standard protocol. Data was collected prospectively. Results: Since 2002, there were 6 recipients, 2 cystic fibrosis, 2 COPD and 2 fibrosing alveolitis, mean age 52, (range 38 to 64.4) Donors, mean age 29.6 years (range 15–47) died of cerebral trauma in 3, miscellaneous causes in 3. Mean time to asystole after withdrawal of treatment was 36 min (range 16–88). Mean inflated warm ischaemic time was 27 min (range 15–52); with mean total warm ischaemic time of 59 min (range 39–86). Total ischaemic time was 326 min (range 280–389). Early function was excellent in 5 patients. One 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. Three surviving patients have excellent lung function and quality of life. Conclusions: 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 ischaemia for up to an hour.