Innovations for heart or lung transplantation

In order to reduce mortality on the waiting list of patients for heart or lung transplantation, some initiatives are implemented in practice to increase the amount of donations.

Currently in some medical centers in NOW reduce mortality Donation after cardiocirculatory death, known as “DCD donor”, is selected from a waiting list using the ex vivo perfusion technique and organs from hepatitis C donors.

Dr. Mauricio Villavicencio, cardiac and heart transplant surgeon Mayo Clinic in Rochester, Minnesota, He commented in a group interview that these three initiatives made it possible to increase the number of transplants.

The most important source of donors are deceased patients cardiocirculatory, they make up between 10% and 15% in the center, with the ex vivo perfusion technique it is about 20% to 30% (in the lungs not so much is done), and donors with hepatitis C are about 15%.

Villavicencio explained that there are many donors, especially in NOW and Anglo-Saxon countries, in the case of cardiocirculatory death, the patient is not brain dead, but has severe neurological damage, so the family decides not to continue treatment and removes artificial support, mechanical ventilation.

“(…) donor pressure decreases, saturation decreases, finally the heart stops and death is declared and at that moment the heart can be removed,” explained the doctor.

After the cardiectomy was performed, the heart was preserved. cold organ, however, there is another alternative, the placement of a device to assist circulation (ex vivo perfusion) such as ECMO, which is responsible for pumping blood, oxygenating and maintaining organ temperature.

“Then it happens that heart It is no longer cold like before, in the refrigerator, but it is receiving perfusion and beating and can be resuscitated,” assured Villavicencio.

After transplantation, this support is usually used to guarantee a good patient recovery and has increased the average survival after surgery to more than 10 years.

Regarding donors with hepatitis C, the surgeon stated that there used to be a lot of stigma the treatment was very difficult and that was not good, however, with the advent of “antiviral drugs” they began to treat recipients and the vast majority of patients eliminated the virus from their blood within a week or two.

In the United States, overdose donors are 20%, in some parts around 30%, and many test positive for hepatitis C. “So it’s a very important and very safe source of organs because the results have been very good,” Villavicencio said.