Organ Assist: UMCG puts donor organ per­fu­sion unit into use

Groningen, The Netherlands, 13 February 2015 The ‘Organ Preservation & Resuscitation’ unit in the oper­a­tion cen­tre can pre­serve four donor organs in four per­fu­sion machines at the same time. The unit imple­ment­ed Organ Assist’s Kidney Assist, Liver Assist, lung Assist and ECOPS. The machines ensure that the organs are con­tin­u­al­ly rinsed with oxy­gen-enriched flu­id and nutri­ents for sev­er­al hours before trans­plan­ta­tion. The organs can also be kept warm. Years of research have shown that this method is the best way to pre­serve organs such as lungs, liv­er and kid­neys, and even enhance the qual­i­ty.
Preservation and qual­i­ty
Until now, dur­ing pro­cure­ment, donor organs were rinsed once with cold, deoxy­genat­ed preser­va­tion flu­id before being stored on ice. This ‘cold stor­age’ brought the metab­o­lism of the organ to a vir­tu­al stand­still, enabling the organ to ‘sur­vive’ with­out oxy­gen. However, the qual­i­ty of the organ dete­ri­o­rat­ed dur­ing the preser­va­tion peri­od, and the risk of it being unable to resume nor­mal func­tion after trans­plan­ta­tion increased. In addi­tion, increas­ing num­bers of donors suf­fer from con­di­tions such as dia­betes and obe­si­ty, which means that he qual­i­ty of their organs is already com­pro­mised. However, these organs are vital in terms of trans­plants, because the sup­ply of donor organs still falls short of demand
Better func­tion
Mechanical per­fu­sion enhances the preser­va­tion and qual­i­ty of donor organs. The process of dying caus­es inflam­ma­to­ry sub­stances to be released inside the donor’s body and dam­ages, for exam­ple, the lungs. Fluid then col­lects (ede­ma) in the lungs, ham­per­ing the absorp­tion of oxy­gen and emis­sion of car­bon diox­ide after trans­plan­ta­tion. As a result, oth­er­wise healthy donor lungs are some­times declined for trans­plan­ta­tion because they have been dam­aged dur­ing the process of dying. Mechanical per­fu­sion can remove the flu­id from the lungs, and make them suit­able for trans­plan­ta­tion. In some donors, who have died after car­diac arrest, dam­age may also occur due to absence of blood cir­cu­la­tion dur­ing a cer­tain time peri­od. In the case of kid­neys, this could lead to the recip­i­ent being put back on dial­y­sis for a while after the trans­plant. Kidneys that have been treat­ed with mechan­i­cal per­fu­sion are more like­ly to work prop­er­ly imme­di­ate­ly after trans­plan­ta­tion, mak­ing dial­y­sis unnec­es­sary. Livers also ben­e­fit from mechan­i­cal per­fu­sion. Patients who receive a liv­er from a car­diac-dead donor often devel­op bile duct prob­lems after the trans­plant. Administering oxy­gen to the donor liv­er via machine per­fu­sion can reduce this risk.
From research to clin­i­cal prac­tice
UMCG and Organ Assist have spent many years research­ing stor­age and preser­va­tion tech­niques for donor organs. Several inno­v­a­tive prod­ucts have been devel­oped, includ­ing oxy­gen-enriched mechan­i­cal per­fu­sion sys­tems, that are man­u­fac­tured and mar­ket­ed by Organ Assist. The tech­nique dif­fers depend­ing on the organ and the stage of tech­ni­cal devel­op­ment of the sys­tem. In 2013, the UMCG launched two brand new tech­niques. One involved donor lungs that had ini­tial­ly been reject­ed, suit­able for trans­plant, and the oth­er kept iso­lat­ed donor liv­ers alive at body tem­per­a­ture. These new tech­niques are now being used in clin­i­cal prac­tice in the organ per­fu­sion unit.
Since 2013, the UMCG has car­ried out a total of 26 pilot stud­ies, where­by patients were giv­en trans­plants using donor lungs, liv­ers and kid­neys that had under­gone mechan­i­cal per­fu­sion. As the devel­op­ment and use of mechan­i­cal per­fu­sion dif­fers per donor organ, it is not yet stan­dard treat­ment for all donor organs. At the moment, lungs from donor with lung ede­ma are treat­ed with mechan­i­cal per­fu­sion in the organ per­fu­sion unit in the UMCG before being trans­plant­ed.
Randomized con­trolled tri­als (RTCs) using donor liv­ers and kid­neys (some of which will have been decline for trans­plan­ta­tion) will be car­ried out in the forth­com­ing peri­od to opti­mize the results of trans­plant­i­ng these organs even fur­ther. These organs will also be pre­served and opti­mized in the organ per­fu­sion unit. Mechanical per­fu­sion is expect­ed to increase the num­ber of trans­plants using organs from deceased donors. This means that the aver­age num­ber of lung trans­plant oper­a­tions per­formed in the Netherlands every year (cur­rent­ly 70) could increase by 10 to 20 trans­plants.
On Friday February 13th 2015 the famous Dutch TV show had an item about the new treat­ments at the UMC Groningen. Surgeons and per­fu­sion spe­cial­ists Robert Porte and Michiel Erasmus were invit­ed to talk about the tech­niques they are using in their new and ded­i­cat­ed Organ Perfusion Room.

Leave a Reply

Your email address will not be published. Required fields are marked *