Iyer, Arjun and Chew, Hong Chee and Gao, Ling and Villanueva, Jeanette and Hicks, Mark and Doyle, Aoife and Kumarasinghe, Gayathri and Jabbour, Andrew and Jansz, Paul Cassius and Feneley, Michael P and Harvey, Richard P and Graham, Robert M and Dhital, Kumud K and Macdonald, Peter S (2016) Pathophysiological Trends During Withdrawal of Life Support: Implications for Organ Donation After Circulatory Death. Transplantation, 100 (12). pp.2621-2629. ISSN 1534-6080 (OA)
Full text not available from this repository.Abstract
BACKGROUND
Donation after circulatory death (DCD) provides an alternative pathway to deceased organ transplantation. Although clinical DCD lung, liver, and kidney transplantation are well established, transplantation of hearts retrieved from DCD donors has reached clinical translation only recently. Progress has been limited by concern regarding the viability of DCD hearts. The aim of this study was to document the pathophysiological changes that occur in the heart and circulation during withdrawal of life (WLS) support.
METHODS
In a porcine asphyxia model, we characterized the hemodynamic, volumetric, metabolic, biochemical, and endocrine changes after WLS for up to 40 minutes. Times to circulatory arrest and electrical asystole were recorded.
RESULTS
After WLS, there was rapid onset of profound hypoxemia resulting in acute pulmonary hypertension and right ventricular distension. Concurrently, progressive systemic hypotension occurred with a fall in left atrial pressure and little change in left ventricular volume. Mean times to circulatory arrest and electrical asystole were 8 ± 1 and 16 ± 2 minutes, respectively. Hemodynamic changes were accompanied by a rapid fall in pH, and rise in blood lactate, troponin-T, and potassium. Plasma noradrenaline and adrenaline levels rose rapidly with dramatic increases in coronary sinus levels indicative of myocardial release.
CONCLUSIONS
These findings provide insight into the nature and tempo of the damaging events that occur in the heart and in particular the right ventricle during WLS, and give an indication of the limited timeframe for the implementation of potential postmortem interventions that could be applied to improve organ viability.
| Item Type: | Article |
|---|---|
| Additional Information: | This article is available for free from the publisher's website. |
| Subjects: | R Medicine > R Medicine (General) |
| Depositing User: | Repository Administrator |
| Date Deposited: | 23 Nov 2016 00:52 |
| Last Modified: | 14 May 2018 04:12 |
| URI: | https://eprints.victorchang.edu.au/id/eprint/517 |
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