Anaise D, Smith R, Ishimaru M, Waltzer W C, Shabtai M, Hurley S, Rapaport F T
Department of Surgery (Transplantation Service), State University of New York, Stony Brook.
Transplantation. 1990 Feb;49(2):290-4. doi: 10.1097/00007890-199002000-00013.
Effective utilization of nonheartbeating cadaver donor organs is limited by the time required to obtain the necessary family consent prior to organ retrieval (a delay of at least 4-6 hr); this exceeds by far the maximum tolerance of kidneys to warm ischemia. Measures that could theoretically permit use of such organs include: (1) rapid in situ flush cooling; (2) continued in situ kidney cooling until permission for donation is secured; and (3) cell-membrane stabilization of vital organs, with only minimal invasion of the donor body. These measures were tested experimentally in dogs. Hemorrhagic shock was produced in mongrel dogs. One hour after cessation of heartbeat, a rapid perfusion tube was placed into the femoral artery; it was advanced, and its balloon was inflated in the aorta above the renal vessels. The kidneys were then flushed in situ with 1000 cc of cold preservation solution containing a calmodulin inhibitor, trifluoperazine. Two other catheters were inserted percutaneously into the peritoneal cavity for continuous intraperitoneal cold perfusion. Core temperatures of 4 degrees C were maintained in situ in the kidneys for 5 hr. Six hours after cardiac arrest, the kidneys were removed and preserved ex vivo at 4 degrees C for 24 hr, and were then transplanted into their respective hosts (n = 11), where they sustained life uneventfully. This method requires a 2-inch incision in the groin of the prospective donor, and two small stab wounds of the abdomen; i.e., semi-invasive procedures which are commonly performed in emergency rooms. The perfused body could then be released to the family if donation is denied. The recently documented increased willingness of the public to donate organs when the termination of life support is not an issue, and court decisions that have authorized the performance of nondeforming diagnostic procedures in cadavers without consent, suggest that the salvage of transplantable semi-invasive procedures described in this study may be useful in helping to alleviate the current shortage of transplantable organs. This technique can provide the time needed for families to consider the option of organ donation from nonheartbeating cadaver donors in an unhurried and unpressured manner, while preserving the viability of vital organs during the decision-making process.
非心跳尸体供体器官的有效利用受到器官获取前获得必要的家属同意所需时间（至少延迟4 - 6小时）的限制；这远远超过了肾脏对热缺血的最大耐受时间。理论上可以允许使用此类器官的措施包括：（1）快速原位冲洗降温；（2）持续原位肾脏降温直至获得捐赠许可；（3）仅对供体身体进行最小程度的侵入，对重要器官进行细胞膜稳定处理。这些措施在狗身上进行了实验测试。对杂种狗造成失血性休克。心跳停止1小时后，将一根快速灌注管插入股动脉；推进该管并在肾血管上方的主动脉中充盈其球囊。然后用1000毫升含有钙调蛋白抑制剂三氟拉嗪的冷保存溶液对肾脏进行原位冲洗。另外两根导管经皮插入腹腔进行持续的腹腔内冷灌注。肾脏原位核心温度维持在4摄氏度达5小时。心脏骤停6小时后，取出肾脏并在4摄氏度下离体保存24小时，然后移植到各自的受体（n = 11）体内，它们在受体体内平稳维持生命。该方法需要在前瞻性供体的腹股沟处做一个2英寸的切口以及腹部两个小的穿刺伤口；即半侵入性手术，这在急诊室是常见操作。如果捐赠被拒绝，然后可以将灌注后的尸体交还给家属。最近记录显示，当生命支持的终止不是问题时公众捐赠器官的意愿增加，以及法院判决授权在未经同意的尸体上进行无变形诊断程序，表明本研究中描述的可挽救的半侵入性手术技术可能有助于缓解当前可移植器官短缺的问题。这种技术可以提供时间让家属从容且无压力地考虑从非心跳尸体供体捐赠器官的选择，同时在决策过程中保持重要器官的活力。
