Distant organ procurement in clinical lung- and heart-lung transplantation *1Cooling by extracorporeal circulation or hypothermic flush

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Abstract
The scarcity of suitable donors for single lung and heart-lungtransplantation calls for methods of medium-term pulmonary preservation toallow for distant organ procurement. At our institution, the first fivegrafts (four heart-lung, one single lung) were cooled by means of atransportable extracorporeal circulation unit, while the last eight grafts(four heart-lung, four single lung) were flush-perfused with modified coldEuro-Collins solution. The technique of extracorporated circulationincluded aortic and right atrial cannulation and cooling to 12 degrees-14degrees C (rectal temperature) using a bubble oxygenator. Bypass timesranged between 41 and 52 min. Following excision, the organs weretransported in ice-cold donor blood for ischemic times from 171 to 310 min.For cold flush preservation, simultaneous coronary (cold St. Thomas'ssolution) and pulmonary artery perfusion (Euro- Collins solution, 50 ml/kgover 4 min) were initiated simultaneously. The organs were transported incold Euro-Collins solution for ischemic times of 175 to 270 min. Inheart-lung transplantations the first postoperative arterial PO2 uponarrival at the intensive care unit was 120 +/- 38 Torr in theextracorporeal circulation and 140 +/- 38 Torr in the Euro-Collins solutiongroup. Six of eight patients were extubated within 48 h aftercardiopulmonary grafting. We conclude that pulmonary function followingheart-lung or single lung preservation with simple hypothermic flush is asgood or better than that following extracorporeal circulation. Sincedistant organ retrieval is much more convenient without the latter,preservation using Euro-Collins solution is preferred.

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