Transplantation of lungs from a non-heart-beating donor
Transplantation of lungs from a non-heart-beating donor
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DOI：
10.1016/s0140-6736(00)04195-7
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发表时间：
2001-03-17
期刊：
影响因子：
168.9
通讯作者：
Algotsson, L
中科院分区：
文献类型：
--
作者：
Steen, S;Sjöberg, T;Algotsson, L
背景在动物中，我们以前曾成功地使用无心跳供体的器官进行肺移植。我们还开发了一种在移植前评估这些器官功能的体外系统。下一步是在人类身上尝试这项技术。考虑到涉及的敏感的伦理问题，我们的第一个目的是找出什么程序是可以接受的，并使用结果来指导临床肺移植从non-heartbeating donor.Methods的伦理可接受性的研究是衡量的结果，广泛的信息计划针对公众在瑞典，并从讨论与专业人士，包括医生，护士，医院牧师和法官捐献者是一名心肺复苏失败后死于心脏重症监护室急性心肌梗死的患者。近亲允许在完整的身体内冷却肺部，并在死亡后65分钟开始胸膜内冷却。血液样本被送去进行病毒学检测和交叉配血。然后，亲属有时间与死者独处。3小时后，将尸体运送到手术室，并移除心肺阻滞。肺进行评估离体，和身体被运送到病理科尸检。结果没有发现移植禁忌症，右肺移植成功到一个54岁的女性慢性阻塞性肺疾病。供体肺在再灌注和通气后仅5分钟表现出良好的功能，并且在随访的前5个月期间，移植肺的功能一直良好。这一群体可能是肺供体的潜在来源。当瑞典的所有医院和救护人员都接受了无心跳肺捐赠的培训后，我们希望能够为所有需要肺移植的患者提供足够的高质量的捐赠肺。
Background In animals, we have previously done successful lung transplantations using organs from non-heart-beating donors. We have also developed an ex-vivo system of assessing the function of such organs before transplantation. The next stage was to try the technique in human beings. Bearing in mind the sensitive ethical issues involved, our first aim was to find out what procedures would be acceptable, and to use the results to guide a clinical lung transplantation from a non-heart-beating donor.Methods The ethical acceptability of the study was gauged from the results of a broad information programme directed at the general public in Sweden, and from discussions with professionals including doctors, nurses, hospital chaplains, and judges. The donor was a patient dying of acute myocardial infarction in a cardiac intensive-care unit after failed cardiopulmonary resuscitation. The next of kin gave permission to cool the lungs within the intact body, and intrapleural cooling was started 65 min after death. Blood samples were sent for virological testing and cross matching. The next of kin then had time to be alone with the deceased. After 3 h, the body was transported to the operating theatre and the heart-lung block removed. The lungs were assessed ex vivo, and the body was transported to the pathology department for necropsy.Results No contraindications to transplantation were found, and the right lung was transplanted successfully into a 54-year-old woman with chronic obstructive pulmonary disease. The donor lung showed excellent function only 5 min after reperfusion and ventilation, and during the first 5 months of follow-up, the function of the transplanted lung has been good.Interpretation About half the deaths in Sweden are caused by cardiac and cerebrovascular disease. This group could be a potential source of lung donors. When all hospitals and ambulance personnel in Sweden have received training in non-heart-beating lung donation, we hope that there will be enough donor lungs of good quality for all patients needing a lung transplant.