Overcoming challenges of lung recovery from uDCDDs - Felicidades!
Overcoming challenges of lung recovery from uDCDDs - Felicidades!
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克服 uDCDD 肺部恢复的挑战 - 祝你好运！
DOI：
10.1111/ajt.15506
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Requard3rd,JohnJacob
中科院分区：
文献类型：
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作者：
Egan,ThomasM;Requard3rd,JohnJacob
我们写信祝贺 Suberviola 博士及其同事成功移植了通过死亡捐献者循环测定后不受控制的捐献 (uDCDD) (1) 恢复的肺。尽管他们的机构并不位于人口稠密地区，但他们令人信服地证明 uDCDD 可以提供可以安全移植的肺部。他们出色的生存率（仅 1 人死于败血症，7 名幸存者，平均随访 52 个月）非常令人鼓舞，这可能归功于他们仔细而严格的选择标准。显然，uDCDD 可以安全地添加到肺供体库中，以增加肺移植的数量。无 CLAD 生存期是多少？八名患有终末期肺病的患者接受了肺移植，如果不使用这种新的供体来源，这可能不会发生。值得注意的是，三例肺移植手术是在 450 公里外的另一家医院进行的。在美国，FDA 认为 uDCDD 肺部的离体肺灌注 (EVLP) 处于研究阶段，这就是为什么我们获得了研究设备豁免，以进行 NIH 资助的研究，评估使用 Steen 溶液从 uDCDD 中恢复的 EVLP 肺部 (2)。我们同意作者的说法，即从 uDCDD 中恢复器官“需要制定旨在促进此类捐赠的新策略”。我们发现，许多潜在的 uDCDD 都存在无法进行移植（尤其是肺移植）的医疗合并症。我们的器官获取组织（OPO）坚持要获得近亲（NOK）的同意，即使死者已登记，或第一人授权（FPA）器官捐献者。这与西班牙在器官回收前获得NOK同意的政策类似。在美国，修订后的《统一解剖捐赠法》(UAGA) 在 50 个州中的 47 个州获得通过，专门禁止 NOK 撤销 FPA 个人器官捐赠的许可 (3)。这为 FPA 提供了与预先指令相同的法律“权重”。北卡罗来纳州 (NC) 总检察长办公室认定，NC UAGA 不仅允许我们的 OPO 从 FPA 死者处获取肺，而且还允许我们的 OPO 获取肺。 NC UAGA 要求我们的 OPO
We write to congratulate Dr. Suberviola and colleagues for their success transplanting lungs recovered from uncontrolled Donation after Circulatory Determination of Death donors (uDCDDs)(1). Although their institution is not in a densely populated area, they showed convincingly that uDCDDs can provide lungs that can be safely transplanted. Their excellent survival (only one death from sepsis with 7 survivors, mean follow-up 52 months), is very encouraging and may be due to their careful and rigorous selection criteria. Clearly, uDCDDs can safely add to the lung donor pool to increase the number of lung transplants. What was the CLAD-free survival?Eight patients suffering from end-stage lung disease received lung transplants that may not have happened without using this new donor source. Notably, three lung transplants were performed in another hospital 450 km away. In the US, the FDA considers ex-vivo lung perfusion (EVLP) of lungs from uDCDDs investigational, which is why we acquired an Investigational Device Exemption to perform our NIH-funded study assessing lungs recovered from uDCDDs with EVLP using Steen solution (2). We concur with the authors’ claim that organ recovery from uDCDDs “requires the development of new strategies designed to facilitate this type of donation.” We found that many potential uDCDDs had medical comorbidities precluding transplant, or lung transplant in particular. Our organ procurement organization (OPO) insisted on obtaining consent from next-of-kin (NOK), even if decedents were registered, or first-person authorized (FPA) organ donors. This is similar to the policy in Spain of obtaining consent from NOK before organ recovery. In the US, the amended Uniform Anatomical Gift Act (UAGA), which was passed in 47 of 50 states, specifically prevents NOK from revoking permission for organ donation from FPA individuals (3). This provides FPA with the same legal “weight” as an advanced directive. The North Carolina (NC) Attorney General’s office determined the NC UAGA not only allowed our OPO to acquire lungs from FPA decedents; the NC UAGA required our OPO to