Outcomes of lung transplantation from organ donation after medical assistance in dying: First North American experience.
clinical research/practice
donors and donation
donors and donation: donation after circulatory death (DCD)
donors and donation: extended criteria
lung transplantation/pulmonology
organ procurement
organ transplantation in general
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
revised:
10
01
2022
received:
08
12
2021
accepted:
23
01
2022
pubmed:
3
2
2022
medline:
10
6
2022
entrez:
2
2
2022
Statut:
ppublish
Résumé
Over 2.5% of deaths in Canada occur as a result from medical assisting in dying (MAID), and a subset of these deaths result in organ donation. However, detailed outcomes of lung transplant recipients using these donors is lacking. This is a retrospective single center cohort study comparing lung transplantation outcomes after donation using MAID donors compared to neurologically determined death and controlled donation after circulatory death (NDD/cDCD) donors from February 2018 to July 2021. Thirty-three patients received lungs from MAID donors, and 560 patients received lungs from NDD/cDCD donors. The donor diagnoses leading to MAID provision were degenerative neurological diseases (n = 33) and end stage organ failure (n = 5). MAID donors were significantly older than NDD/cDCD donors (56 [IQR 49-64] years vs. 48 [32-59]; p = .0009). Median ventilation period and 30 day mortality were not significantly different between MAID and NDD/cDCD lungs recipients (ventilation: 1 day [1-3] vs 2 days [1-3]; p = .37, deaths 0% [0/33] vs. 2% [11/560], p = .99 respectively). Intermediate-term outcomes were also similar. In summary, for lung transplantation using donors after MAID, recipient outcomes were excellent. Therefore, where this practice is permitted, donation after MAID should be strongly considered for lung transplantation as a way to respect donor wishes while substantially improving outcomes for recipients with end-stage lung disease.
Identifiants
pubmed: 35108446
doi: 10.1111/ajt.16971
pii: S1600-6135(22)08245-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1637-1645Informations de copyright
© 2022 The American Society of Transplantation and the American Society of Transplant Surgeons.
Références
Canada H. Second Annual Report on MEDICAL ASSISTANCE IN DYING IN Canada. https://www.canada.ca/content/dam/hc-sc/documents/services/medical-assistance-dying/annual-report-2020/annual-report-2020-eng.pdf Published 2020 Accessed October 27, 2021
Ball IM, Healey A, Keenan S, et al. Organ donation after medical assistance in dying - Canada's first cases. N Engl J Med. 2020;382(6):576-577.
Downar J, Shemie SD, Gillrie C, et al. Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy. CMAJ. 2019;191(22):E604-E613.
Detry O, Le Dinh H, Noterdaeme T, et al. Categories of donation after cardiocirculatory death. Transplant Proc. 2012;44(5):1189-1195.
Kootstra G, Daemen JH, Oomen AP. Categories of non-heart-beating donors. Transplant Proc. 1995;27(5):2893-2894.
Healey A, Watanabe Y, Mills C, et al. Initial lung transplantation experience with uncontrolled donation after cardiac death in North America. Am J Transplant. 2020;20(6):1574-1581.
Downar J, Fowler RA, Halko R, Huyer LD, Hill AD, Gibson JL. Early experience with medical assistance in dying in Ontario, Canada: a cohort study. CMAJ. 2020;192(8):E173-E181.
Healey A, Cypel M, Pyle H, et al. Lung donation after medical assistance in dying at home. Am J Transplant. 2020;21(1):415-418. 10.1111/ajt.16267
Cypel M, Yeung JC, Liu M, et al. Normothermic ex vivo lung perfusion in clinical lung transplantation. N Engl J Med. 2011;364(15):1431-1440.
Cypel M, Yeung JC, Machuca T, et al. Experience with the first 50 ex vivo lung perfusions in clinical transplantation. J Thorac Cardiovasc Surg. 2012;144(5):1200-1206.
Cypel M, Yeung JC, Hirayama S, et al. Technique for prolonged normothermic ex vivo lung perfusion. J Heart Lung Transplant. 2008;27(12):1319-1325.
Snell GI, Oto T, Levvey B, et al. Evaluation of techniques for lung transplantation following donation after cardiac death. Ann Thorac Surg. 2006;81(6):2014-2019.
Qaqish R, Watanabe Y, Hoetzenecker K, et al. Impact of donor time to cardiac arrest in lung donation after circulatory death. J Thorac Cardiovasc Surg. 2021;161(4):1546-1555 e1541.
Yeung JC, Cypel M, Machuca TN, et al. Physiologic assessment of the ex vivo donor lung for transplantation. J Heart Lung Transplant. 2012;31(10):1120-1126.
Levy L, Huszti E, Tikkanen J, et al. The impact of first untreated subclinical minimal acute rejection on risk for chronic lung allograft dysfunction or death after lung transplantation. Am J Transplant. 2020;20(1):241-249.
Stewart S, Fishbein MC, Snell GI, et al. Revision of the 1996 working formulation for the standardization of nomenclature in the diagnosis of lung rejection. J Heart Lung Transplant. 2007;26(12):1229-1242.
Bollen J, de Jongh W, Hagenaars J, et al. Organ donation after euthanasia: a Dutch practical manual. Am J Transplant. 2016;16(7):1967-1972.
Detry O, Laureys S, Faymonville M-E, et al. Organ donation after physician-assisted death. Transpl Int. 2008;21(9):915.
Ysebaert D, Van Beeumen G, De Greef K, et al. Organ procurement after euthanasia: Belgian experience. Transplant Proc. 2009;41(2):585-586.
Holmes BB, Diamond MI. Amyotrophic lateral sclerosis and organ donation: is there risk of disease transmission? Ann Neurol. 2012;72(6):832-836.
Bollen J, Ten Hoopen R, Ysebaert D, van Mook W, van Heurn E. Legal and ethical aspects of organ donation after euthanasia in Belgium and the Netherlands. J Med Ethics. 2016;42(8):486-489.
van Reeven M, Gilbo N, Monbaliu D, et al. Evaluation of liver graft donation after euthanasia. JAMA Surg. 2020;155(10):917-924.
van Suylen V, Bunnik EM, Hagenaars JAM, et al. Ex situ perfusion of hearts donated after euthanasia: a promising contribution to heart transplantation. Transplant Direct. 2021;7(3):e676.
Van Raemdonck DVG, Dupont L, Ysebaert D, et al. Initial experience with transplantation of lungs recovered from donors after euthanasia. Applied Cardiopulmonary Pathophysiology. 2011;15:38-48.
Ceulemans LJ, Vandervelde C, Neyrinck AP, et al. Donation after euthanasia (DCD-V) results in excellent long-term outcome after lung transplantation, equal to donation after brain death (DBD) and circulatory death (DCD-III). J Heart Lung Transplant. 2020;39(4):S140-141.