NON-HEART-BEATING DONORS - A MODEL OF THORACIC ALLOGRAFT INJURY

Background. Non-heart-beating donors (NHBDs) have been proposed for th e critical shortage of donors for cardiac and pulmonary transplantatio n. We determined the effects oi prearrest hypoxia and postarrest warm ischemia on cardiac and pulmonary allografts procured from NHBDs under going hypoxic arrest. Methods. Rabbit hearts and lungs were procured f rom separate donors and placed on isolated blood perfusion circuits. C ontrols were excised and perfused without ischemia. Hearts from NHBDs underwent either prearrest hypoxic perfusion alone or consecutive peri ods of prearrest hypoxic perfusion and 20 minutes of postarrest warm i schemia. A third group of hearts underwent 30 minutes of warm, global ischemia alone. Two groups of pulmonary allografts were studied using similar hypoxic perfusion/20-minute ischemia and 30-minute ischemia do nors. Results. prearrest hypoxic perfusion clearly causes significant dysfunction of cardiac allografts from NHBDs compared with nonischemic controls. Prearrest hypoxic perfusion combined with postarrest ischem ia results in an additive degree of dysfunction more severe than a sim ilar period of warm ischemia alone. Both groups of experimental lungs displayed function similar to that of nonischemic controls in terms of pulmonary hemodynamics, airway resistance, and oxygenation potential. Conclusions. We conclude that prearrest hypoxic perfusion significant ly contributes to the dysfunction of NHBD cardiac allografts. Pulmonar y allografts may be more amenable to procurement of NHBDs.