Pre-arrest heparinization and ventilation during warm ischemia preserves lung function in non-heart-beating donors

Background/Purpose: To solve the problem of donor scarcity, many attempts h ave been made including improved community education, relaxed organ accepta nce criteria, increased reliance on single lung transplantation, and the us e of partial organ donation. Unfortunately, these efforts have produced onl y modest increases in lung allograft availability; therefore, the so-called non-heart-beating organ donation must be considered. The aim of this study is to assess the viability of the non-heart-beating donor (NHBD) lung tran splant rat model and determine the best strategy to manage the donor before and after cardiac arrest. Methods: Fifty-five inbred Fischer rats were used as donors and recipients in an isogenic model of left lung transplantation. The rats were divided in to 6 groups (n = 5): group I, normal controls without transplant; group II, heart-beating donor controls (HBD); group III, NHBD, no heparin, no ventil ation during warm ischemia; group IV, NHBD, heparin, no ventilation; group V, NHBD, no heparin, ventilation; group VI, NHBD, heparin, ventilation. All lungs were stored at 4 degrees C for 4 hours. Animals were killed 24 hours after implantation. Gas exchange, pulmonary artery pressure, compliance, c hest x-ray score, and histological score were assessed. Results: Heparinized and ventilated animals during warm ischemia (group VI) had similar performance than those transplanted without warm ischemia time in a scenario of heart-beating donor (group II). Groups III, IV, and V tra nsplanted lungs showed severe damage. Conclusions: The authors conclude that the rat lung transplantation model i s useful to study the phenomena that occur in a setting of transplantation using NHBD and that heparinization and ventilation before cardiac arrest is the best strategy to manage non-heart-beating donors in this model. J Pedi atr Surg 34:1805-1809. Copyright (C) 1999 by W.B. Saunders Company.