ESTABLISHMENT OF MULTIORGAN PROCUREMENT SYSTEM FROM NO-HEART-BEATING DONOR USING PERCUTANEOUS CARDIOPULMONARY BYPASS

供体短缺是器官移植中最严重的问题之一。使用非心脏捐献者可能会极大地扩大捐赠者的数量。本研究探讨经皮心肺支持（PCPS）对非心脏跳动供者多器官复苏的方法。方法：13只beagle犬在静脉给予前列环素、维拉帕米、心得安和甲磺酸萘莫司他后，用溴化环铵窒息并停止呼吸支持。在尸体中留下器官30分钟后，用ppps再灌注1小时，起爆液包括上图所示的四种药物和KCl。心脏Tx (HTx): 8颗心脏在UW溶液中保存24小时，采用终末白细胞衰竭血停搏法原位移植。单肺Tx (LTx): 5颗左肺原位移植。肾移植（RTx）： 3个肾异位移植于腹股沟。结果：所有供体心脏均在窒息后20分钟内停止跳动，无心室颤动。HTx：所有移植物自发加热，所有动物断奶体外循环，不使用儿茶酚胺。LTx：供肺肺静脉血O2压和CO2压与受体（对照）肺无明显差异。所有的动物都能存活到肺被排斥。RTx：所有移植肾在再灌注后很快产生尿，输出量大于1ml /Kg。结论：经四种药物预处理后，经ppps活化的非心脏供体的心脏、肺和肾脏移植成功，可扩大供体池。

Donor shortage is one of the most serious problem in organ transplantation (Tx). Use of non-heart-beating donors may extremely expand donor pools. In this study, the method of reanimation of multiple organs in non-heart-beating donor by percutaneous cardiopulmonary support (PCPS) was evaluated.Methods : 13 beagle dogs were asphyxiated with pancronium bromide and cessation of respiratory support after giving prostacyclin, verapamil, propranolol and nafmostat mesilate, intravenously. After leaving organs for 30 minutes in the dead body, the body was reperfused by PCPS for 1 hour with the priming fluid including four drugs shown above and KCl. Heart Tx (HTx) : 8 heart was preserved in UW solution for 24 hours and transplanted orthotopically with using terminal leukocyte-depleted blood cardioplegia Single lung Tx (LTx) : 5 left lung were transplanted orthotopically. Renal Tx (RTx) : 3 kidneys were transplanted heterotopically in the groin.Results : All donor hearts stopped within 20 minutes after asphyxia without ventricular fibrillation. HTx : All grafts beated spontaneously and all animals was weaned from cardiopulmonary bypass without using catecholamine. LTx : The O2 pressure and CO2 pressure of pulmonary vein blood of donor lung were not different from those of the recipient (control) lung. All animals could survived until the lung was rejected.RTx : All transplanted kidney make urine soon after reperfusion with more than 1 ml/Kg of output.Conclusions : These data suggested that hearts, lungs and kidneys from non-heart-beating donor which were pretreated with four drugs and reanimated with PCPS be transplanted successfully and that this method may expand donor pool.