Normothermic perfusion of donor lungs for preservation and evaluation using the OCS device – the first 10 patients at Hannover Medical School

Cold preservation of donor organs is the standard practise in lung transplantation and is regarded reasonably successful as long as ischemia times are not excessive and donor organ quality is high. The donor organ shortage and growing waiting lists have, however, forced transplant programs to accept longer ischemic times and increasingly marginal donor organs. Normothermic perfusion of marginal donor lungs for evaluation has been described by various groups, but all devices used to date are static. Here, we report on the use of the portable organ care system (OCS, Transmedics Inc.) device for concomitant preservation, transport and evaluation of donor lungs.

Between February 2011 and July 2011, the OCS device was used in 10 unselected lung retrievals. Cases were not strictly consecutive, however, decision policy for utilizing the device was based on availability of the necessary surgical and technical staff. Lungs were first perfused with Perfadex solution, then immediately connected to the OCS device and perfused with warm perfusate enriched with 2 red cell concentrates. All 10 lungs procured with OCS were transplanted.

Donors (7 female/3 male) were 43.1 (range 14–72) years old. PaO2/FiO2 ratio in the donor was 468.7±96.2mmHg. Final PaO2/FiO2 ratio on OCS was 501.7±128.9mmHg. Recipients (6 female/4 male) were 52.0 (range 43–59) years old. Underlying diagnoses were idiopathic pulmonary fibrosis (6), COPD (2) and idiopathic pulmonary hypertension (2). 8/10 recipients were listed urgent or highly urgent, 2 were on ECMO preoperatively. All recipients recovered reasonably well and were discharged from hospital. A retrospective matched pair analysis comparing the 10 OCS cases to 10 cases with regular flush-perfused lungs matched for diagnosis, age and urgency status revealed a trend of shorter postoperative mechanical ventilation times in OCS cases.

We conclude that unselected donor lungs, including marginal organs, can be safely preserved using the OCS device, resulting in 100% organ utilization and successful transplantation in all cases. This holds true for the real-life scenario of unselected recipients. A prospective, randomized, multi-centred trial for comparing OCS-preserved to standard flush-perfused donor lungs is currently underway.