Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofía, Córdoba, Spain.
Group for the Study of Thoracic Neoplasms and Lung Transplantation, IMIBIC (Instituto Maimónides de Investigación Biomédica de Córdoba), University of Córdoba, Córdoba, Spain.
Transpl Int. 2024 May 1;37:12659. doi: 10.3389/ti.2024.12659. eCollection 2024.
The main limitation to increased rates of lung transplantation (LT) continues to be the availability of suitable donors. At present, the largest source of lung allografts is still donation after the neurologic determination of death (brain-death donors, DBD). However, only 20% of these donors provide acceptable lung allografts for transplantation. One of the proposed strategies to increase the lung donor pool is the use of donors after circulatory-determination-of-death (DCD), which has the potential to significantly alleviate the shortage of transplantable lungs. According to the Maastricht classification, there are five types of DCD donors. The first two categories are uncontrolled DCD donors (uDCD); the other three are controlled DCD donors (cDCD). Clinical experience with uncontrolled DCD donors is scarce and remains limited to small case series. Controlled DCD donation, meanwhile, is the most accepted type of DCD donation for lungs. Although the DCD donor pool has significantly increased, it is still underutilized worldwide. To achieve a high retrieval rate, experience with DCD donation, adequate management of the potential DCD donor at the intensive care unit (ICU), and expertise in combined organ procurement are critical. This review presents a concise update of lung donation after circulatory-determination-of-death and includes a step-by-step protocol of lung procurement using abdominal normothermic regional perfusion.
肺移植（LT）率增加的主要限制仍然是合适供体的可用性。目前，肺移植供体的最大来源仍然是死后神经判定（脑死亡供体，DBD）后的捐献。然而，只有 20%的此类供体提供可接受的肺移植供体。增加肺供体库的一种拟议策略是使用循环判定死亡（DCD）后的供体，这有可能显著缓解可移植肺的短缺。根据马斯特里赫特分类，DCD 供体有五种类型。前两类是不受控制的 DCD 供体（uDCD）；后三类是受控制的 DCD 供体（cDCD）。不受控制的 DCD 供体的临床经验很少，仍然仅限于小的病例系列。同时，控制性 DCD 供体捐献是最被接受的肺 DCD 捐献类型。尽管 DCD 供体库有了显著增加，但在全球范围内仍未得到充分利用。为了实现高回收率，需要有 DCD 捐献经验、在重症监护病房（ICU）对潜在 DCD 供体进行充分管理以及在联合器官获取方面的专业知识。这篇综述简要介绍了循环判定死亡后的肺捐献，并包括使用腹部常温区域性灌注进行肺获取的分步方案。
