Successful transplantation of lungs from an uncontrolled donor after circulatory death preserved in-situ by alveolar recruitment maneuvers and assessed by ex-vivo lung perfusion

We developed a protocol to procure lungs from uncontrolled donors after circulatory determination of death (NCT02061462). Subjects with cardiovascular collapse, treated on scene by a resuscitation team and transferred to the emergency room, are considered potential donors once declared dead. Exclusion criteria include un-witnessed collapse, no flow period of >15 minutes, and low flow >60 minutes. After death, lung preservation with recruitment maneuvers, Continuous Positive Airway Pressure (CPAP), and protective mechanical ventilation is applied to the donor. After procurement, Ex-Vivo Lung Perfusion (EVLP) is performed. From November 2014 ten subjects were considered potential donors; one of these underwent the full process of procurement, EVLP, and transplantation. The donor was a 46-year-old male who died because of thoracic aortic dissection. Lungs were procured 4 hours and 48 minutes after death, and deemed suitable for transplantation after EVLP. Lungs were then offered to a rapidly deteriorating recipient with cystic fibrosis (LAS 46) who consented to the transplant in this experimental setting. Six months after transplantation, the recipient is in good condition (FEV1 85%) with no signs of rejection. This protocol allowed procurement of lungs from an uncontrolled donor after circulatory determination of death following an extended period of warm ischemia.