Cold ischemic time, defined as the time interval that begins when an organ is cooled with a cold perfusion solution after organ procurement surgery and ends when the organ is implanted, proved to have great impact on the outcome of transplantation. The degree to which the ischemic time affects the outcome of transplantation is related to the sensitivity of that organ to ischemia. In this respect, the most sensitive organ is lung. Cold ischemic time is especially important when the harvested organ should be transported a long distance or within cities with heavy traffic load. We have developed a system for management of cold ischemia to lessen the damage to more sensitive organs. Masih Daneshvari Hospital is the referral center for lung transplantation in Tehran, Iran, with a capable organ procurement center which receives brain death data from more than 56 hospitals in the city. In many jammed traffic hours traveling from many of the referring hospitals to the center takes more than 2-3 hours. Considering the limitation in airborne transportation, taking the harvested lungs takes a considerable amount of time. In our model, when the lungs of a patient is suitable for transplantation, brain dead patient is carefully transported by equipped ambulances to our lung transplantation center and the center takes the responsibility of all organ harvests. As a result, lungs with the most sensitivity to ischemia are protected from damage. This system won’t harm the other harvested organs. Heart, with cold ischemia tolerance of more than lungs, is harvested and in some case is transplanted in our center and in other cases is transported to other centers. In all cases, liver and pancreas should be sent to other city, Shiraz. Kidneys and corneas are also sent to other transplantation center as routine. This system does not interfere with transplantation of other organs but protects the lungs from cold ischemia damage. In addition to cold ischemic time, this method also lets us take better care of the organs by our expert team specialized in brain death management. We can manage the lungs better by sterile endotracheal suctioning and suitable ventilator set up. The other benefits include ease of performing recruitment maneuvers to expand the atelectasis and resolve edemas which ultimately makes unsuitable lungs suitable for transplantation. We recommend other transplantation systems adapt similar harvest policies based on to lower the cold ischemic time of the more sensitive organs.
Volume : 6
Issue : 4
Pages : 196
Transplant Research Center, Massih Daneshvari Hospital, Darabad-Niavaran, Tehran, Iran