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.