期刊
ANNALS OF THORACIC SURGERY
卷 113, 期 6, 页码 1778-1786出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.athoracsur.2020.12.026
关键词
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资金
- Mid-America Transplant Foundation [1 I01 HX002475-01A2]
- Department of Veterans Affairs (Health Services Research Grant) [1 R01HL146856-01A1]
- National Heart, Lung, and Blood Institute (Institute of Public Health, Center for Dissemination and Implementation grant) [2019-01-PG]
- National Institutes of Health [1P01AI116501, R01 HL094601, R01HL151078]
- Veterans Administration Merit Review [1I01BX002730]
- Cystic Fibrosis Foundation
- Foundation for Barnes-Jewish Hospital
This review discusses advances in donor management models, focusing on the specialized donor care facility model. Strategies such as lung protective ventilation, recruitment of atelectatic lung, and hormone therapy can improve lung utilization rates. Stroke volume-based resuscitation is associated with improved heart utilization rates.
BACKGROUND Donor hearts and lungs are more susceptible to the inflammatory physiologic changes that occur after brain death. Prior investigations have shown that protocolized management of potential organ donors can rehabilitate donor organs that are initially deemed unacceptable. In this review we discuss advances in donor management models with particular attention to the specialized donor care facility model. In addition we review specific strategies to optimize donor thoracic organs and improve organ yield in thoracic transplantation. METHODS We performed a literature review by searching the PubMed database for medical subject heading terms associated with organ donor management models. We also communicated with our local organ procurement organization to gather published and unpublished information first-hand. RESULTS The specialized donor care facility model has been shown to improve the efficiency of organ donor management and procurement while reducing costs and minimizing travel and its associated risks. Lung protective ventilation, recruitment of atelectatic lung, and hormone therapy (eg, glucocorticoids and triiodothyronine/thyroxine) are associated with improved lung utilization rates. Stroke volume-based resuscitation is associated with improved heart utilization rates, whereas studies evaluating hormone therapy (eg, glucocorticoids and triiodothyronine/thyroxine) have shown variable results. CONCLUSIONS Lack of high-quality prospective evidence results in conflicting practices across organ procurement organizations, and best practices remain controversial. Future studies should focus on prospective, randomized investigations to evaluate donor management strategies. The specialized donor care facility model fosters a collaborative environment that encourages academic inquiry and is an ideal setting for these investigations. (C) 2022 by The Society of Thoracic Surgeons
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