Steen S, Sjöberg T, Pierre L, Liao Q, Eriksson L, Algotsson L
Heart-Lung Division, University Hospital of Lund, Sweden.
Lancet. 2001 Mar 17;357(9259):825-9. doi: 10.1016/S0140-6736(00)04195-7.
In animals, we have previously done successful lung transplantations using organs from non-heart-beating donors. We have also developed an ex-vivo system of assessing the function of such organs before transplantation. The next stage was to try the technique in human beings. Bearing in mind the sensitive ethical issues involved, our first aim was to find out what procedures would be acceptable, and to use the results to guide a clinical lung transplantation from a non-heart-beating donor.
The ethical acceptability of the study was gauged from the results of a broad information programme directed at the general public in Sweden, and from discussions with professionals including doctors, nurses, hospital chaplains, and judges. The donor was a patient dying of acute myocardial infarction in a cardiac intensive-care unit after failed cardiopulmonary resuscitation. The next of kin gave permission to cool the lungs within the intact body, and intrapleural cooling was started 65 min after death. Blood samples were sent for virological testing and cross matching. The next of kin then had time to be alone with the deceased. After 3 h, the body was transported to the operating theatre and the heart-lung block removed. The lungs were assessed ex vivo, and the body was transported to the pathology department for necropsy.
No contraindications to transplantation were found, and the right lung was transplanted successfully into a 54-year-old woman with chronic obstructive pulmonary disease. The donor lung showed excellent function only 5 min after reperfusion and ventilation, and during the first 5 months of follow-up, the function of the transplanted lung has been good.
About half the deaths in Sweden are caused by cardiac and cerebrovascular disease. This group could be a potential source of lung donors. When all hospitals and ambulance personnel in Sweden have received training in non-heart-beating lung donation, we hope that there will be enough donor lungs of good quality for all patients needing a lung transplant.
在动物实验中，我们此前已成功利用来自非心脏跳动供体的器官进行肺移植。我们还开发了一种在移植前评估此类器官功能的体外系统。下一阶段是在人类身上尝试该技术。考虑到其中涉及的敏感伦理问题，我们的首要目标是找出哪些程序是可接受的，并利用这些结果指导来自非心脏跳动供体的临床肺移植。
该研究的伦理可接受性通过面向瑞典公众的广泛信息项目结果以及与包括医生、护士、医院牧师和法官在内的专业人员的讨论来衡量。供体是一名在心脏重症监护病房因急性心肌梗死在心肺复苏失败后死亡的患者。其近亲同意在完整身体内冷却肺部，死后65分钟开始进行胸膜内冷却。采集血样进行病毒学检测和交叉配型。然后近亲有时间与死者单独相处。3小时后，将尸体运至手术室，取出心肺块。对肺部进行体外评估，然后将尸体运至病理科进行尸检。
未发现移植的禁忌证，右肺成功移植到一名患有慢性阻塞性肺疾病的54岁女性体内。供体肺在再灌注和通气后仅5分钟就显示出优异的功能，在随访的前5个月中，移植肺的功能一直良好。
瑞典约一半的死亡是由心血管和脑血管疾病导致的。这一群体可能是潜在的肺供体来源。当瑞典所有医院和救护人员都接受了非心脏跳动肺捐赠方面的培训后，我们希望能有足够优质的供体肺满足所有需要肺移植的患者。
