Worldwide trends in heart and lung transplantation: Guarding the most precious gift ever

Publication date: Available online 9 August 2017 Source:Best Practice & Research Clinical Anaesthesiology Author(s): Vera von Dossow, Joseph Costa, Frank D'Ovidio, Nandor Marczin Transplantation is sadly a therapy to die for. The survival of the recipient with end stage heart or lung disease requires the demise of a human being via brain death or cessation of circulation with the most noblest final act of offering one’s organs to another. However, transplantation is constrained by severe hemodynamic, regulatory, inflammatory and metabolic stresses in the donor rendering the majority of offered organs unsuitable for transplantation. Coupled with our inability to acquire exact molecular and cellular information and missed opportunities for effectively modulating deteriorations of donors and allografts, anesthesia and critical care contributes to ongoing organ shortages. Progress is made with improving waiting lists by bridging patients for transplantation using mechanical support. However, this represents more complex recipients, higher risk transplant operations and increased resource utilization. The advent of ex vivo perfusion allows implementing novel diagnostic and therapeutic strategies with real potential of reconditioning less ideal organs. This review advocates a paradigm change in critical care management of the potential donor, for improving retrieval practices and for more intellectual involvement of our specialties in organ preservation, ex vivo eva...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research