Table Of ContentOrgan Donation and
Transplantation after
Cardiac Death
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Organ Donation and
Transplantation
after Cardiac Death
Edited by
David Talbot
Anthony M. D’Alessandro
Assistant Editor
Paolo Muiesan
1
1
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Foreword
In 1999 Paul Terasaki wrote an editorial on non-heart-beating (NHB) donation in
clinical transplantation.He stated that NHB donation had the potential to eradicate
the shortage ofkidneys that had frustrated the transplant community ever since the
early days.How close was Paul at that date and has NHB donation done what he
expected?
This book,an initiative oftwo early believers in and supporters ofNHB donation,
depicts the wording ofthis special source oforgans for transplantation and presents
the current situation,not only for kidneys,but for other organs as well.
The book is rich in information on physiology ofischemia,and preservation both
in general and specific for NHB organs.Viability testing has become crucial in NHB
donation and the chapter by David Talbot is leading in this respect.It starts with the
intriguing statement that NHB kidneys might actually be in a better condition then
HB kidneys!
Advanced procedures used to improve the preservation oforgans ‘touched’by
warm ischemia are presented by experts in the field over several chapters.
What makes this book so exceedingly interesting is the fact that the chapters
are written by authors ofdifferent disciplines—for example,an ethicist and a paedi-
atric intensive care specialist write together on the legal and moral issues ofNHB
donation.
The chapters on the European,the USA,and the Japanese settings are very inform-
ative and illustrate a certain diversity,but also that the number ofavailable organs
in all settings has increased! NHB and DCD are used interchangeably without
confusion.
I am convinced that this book will receive a welcome in the transplantation world
as it presents a unique opportunity to increase the availability oforgans for our
patients.
Gauke Kootstra,
Maastricht.
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Preface
Transplantation has been one ofthe most significant advances in health care over the
last 40 years.This success has resulted in a marked increase in the numbers ofpatients
who can benefit from transplantation as indicated by the ever increasing size ofwait-
ing lists throughout the world.While there has been a modest increase in the number
oforgan donors worldwide the disparity between the number ofpotential recipients
and the number ofdeceased donors remains significant.Transplant practitioners have
therefore searched for alternative sources ofdeceased donors including expanding the
criteria for brain dead donors as well as returning to cardiac death donors,which
formed the foundation oftransplantation before the establishment ofbrain death
criteria.As there have been a number ofimprovements in surgical recovery,organ
preservation,immunosuppression and post trasplant patient management,donation
after cardiac death and transplantation has become one way to provide more recipients
the opportunity to experience the benefits oftransplantation.
Recovery oforgans from cardiac death donors requires the cessation ofcardio-
circulatory function,a stand-offperiod followed by declaration ofdeath before organs
can be recovered.After the heart has stopped beating all organs that depend upon
oxygenated blood begin to deteriorate very rapidly.Using organs for transplantation
after such damage carries a risk that they may never work after they are reperfused in
the recipient.A number oftechniques have been developed to allow transplantation
from cardiac death donors to be done successfully.This book has been written
by internationally renowned experts in order to share this knowledge in a rapidly
evolving field.
While there are many practicalities oftransplanting such donor organs there are
also many ethical issues which relate largely to the issues oforgan donation in a non
brain dead patient such as: when does death actually occur? This book also
covers these topics.
David Talbot
Anthony D’Alessandro
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Contents
Contributors xi
1 History ofnon-heart-beating donation 1
Gauke Kootstra
2 Legal,moral,and ethical issues 7
Sam D.Shemie,Michael De Vita
3 History oforgan perfusion in organ transplantation 31
Diethard Monbaliu,Qiang Liu,Katrien Vekemans,Jacques Pirenne
4 Viability testing ofkidneys from non-heart-beating donors 51
David Talbot
5 Perfusate development for the NHBD 67
Colin Wilson
6 Thrombolysis in the non-heart-beating donor 103
David Talbot,Mohamed Gok,Thomas Minor
7 Supplemental cryopreservation ofthe donor by
peritoneal cooling 117
John Asher,Alex Navarro
8 Gaseous oxygen to improve viability ofmarginal or pre-damaged
organ grafts during hypothermic storage 131
Thomas Minor
9 Extracorporeal circulatory-assisted non-heart-beating organ
donation 153
JeffPunch
10 Patient selection and management 161
Julio Pascual,John D.Pirsch
11 The renal biopsy in non-heart-beating organ transplantation 173
M Snoeijs,R.Matthijsen,M.H.Christiaans,J.P.van Hooff,E.van Heurn,
W.Buurman,R.J.van Suylen,C.J.Peutz-Kootstra
12 Early results for renal transplants from non-heart-beating
donors 203
Alex Navarro
13 Liver transplantation using non-heart-beating donors 213
Paolo Muiesan
