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Experience of a Maastrich type II non heart beating donor program in a small city: preliminary results
E Miñambres1, B Suberviola2, C Guerra3
1Servicio de Medicina Intensiva, Trasplantes Hospital Universitario Marqués de Valdecilla, Santander, España; Unidad de Coordinación de Trasplantes, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, España.
Objective:
To study the results of a non-controlled cardiac death (Maastricht type II) donor program in a city of 200,000 inhabitants. The study was initially focused on lung donation and was extended to kidney donation after 9 months.
Design:
A prospective observational study was conducted between October 2012 and December 2013.
Setting:
The Intensive Care Unit of Marqués de Valdecilla University Hospital in Santander (Spain), and surrounding areas.
Populations:
Patients (< 55 years) who died of out-of-hospital cardiac arrest.
Interventions:
All out-of-hospital cardiac arrests were treated with mechanical cardiac compression (LUCAS II). The diagnosis of death and organ preservation were performed in the ICU.
Results:
A total of 14 calls were received, of which three were discarded. Of the 11 potential donors, 7 were effective donors with a median age of 39.5 years (range: 32-48). A total of 5 single lung transplants and four kidney transplants were performed. In addition, corneas and tissues were harvested. The non-valid donors were rejected mainly due to technical problems. There were no donation refusals on the part of the patient relatives. The lung transplant patient survival rate was 100% after one month and 80% after one year. One month after transplantation, the kidney recipients had a serum creatinine concentration of<2mg/dl. The interval from cardiac arrest to renal preservation was 80minutes (range: 71-89), and the interval from cardiac arrest to lung preservation was 84minutes (range: 77-94).
Conclusions:
A Maastricht type II donation program in a small city is viable for both abdominal and thoracic organs. The program was initially very cautious, but its potential is easily improvable by increasing donor and by equipping mobile ICU ambulances with mechanical cardiac compression systems. Full management of the donor in the ICU, avoiding the emergency department or operating rooms, reduces the warm ischemia time, thereby improving transplant outcomes.
