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Organ Preservation

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Transplantation Immunology

Part of the book series: Methods In Molecular Biology™ ((MIMB,volume 333))

Abstract

The success of organ transplantation is critically dependent on the quality of the donor organ. Donor organ quality, in turn, is determined by a variety of factors including donor age and preexisting disease, the mechanism of brain death, donor management prior to organ procurement, the duration of hypothermic storage, and the circumstances of reperfusion. It has been recognized for some time that both the short- and long-term outcomes after cadaveric organ transplantation are significantly inferior to those obtained when the transplanted organ is obtained from a living donor, regardless of whether the donor is related or unrelated to the recipient. Brain death results in a series of hemodynamic, neurohormonal, and pro-inflammatory perturbations, all of which are thought to contribute to donor organ dysfunction. The process of transplantation exposes the donor organ to an obligatory period of ischemia and reperfusion. Traditionally, hypothermic storage of the donor organ has been used to protect it from ischemic injury, but donor organs differ markedly in their capacity to withstand hypothermic ischemia. Data from the Registry of the International Society for Heart and Lung Transplantation indicate that the risk of primary graft failure and death rises dramatically for both the heart and lung as ischemic time increases. Based on these data, maximum recommended ischemic times for the donor heart and lung are 6 and 8 h, respectively. In this chapter, strategies aimed at minimizing the adverse consequences of brain death and ischemia/reperfusion injury to the donor heart and lung are discussed. These strategies are likely to become increasingly important as the reliance on marginal donors increases to meet the growing demand for organ transplantation.

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Author information

Authors and Affiliations

  1. Heart and Lung Transplant Unit and Department of Clinical Pharmacology, St. Vincent’s Hospital, Sydney and Department of Physiology and Pharmacology, University of New South Wales, Australia

    Mark Hicks & Peter S. MacDonald

  2. Transplant Programme, Victor Chang Cardiac Research Institute, Sydney, Australia

    Alfred Hing & Ling Gao

  3. Heart and Lung Transplant Unit, St. Vincent’s Hospital, Australia

    Jonathon Ryan

Authors
  1. Mark Hicks
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  2. Alfred Hing
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  3. Ling Gao
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  4. Jonathon Ryan
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  5. Peter S. MacDonald
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Editor information

Editors and Affiliations

  1. National Heart and Lung Institute, London, UK

    Philip Hornick

  2. National Heart and Lung Institute, Harefield, UK

    Marlene Rose

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© 2006 Humana Press Inc.

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Cite this protocol

Hicks, M., Hing, A., Gao, L., Ryan, J., MacDonald, P.S. (2006). Organ Preservation. In: Hornick, P., Rose, M. (eds) Transplantation Immunology. Methods In Molecular Biology™, vol 333. Humana Press. https://doi.org/10.1385/1-59745-049-9:331

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  • DOI: https://doi.org/10.1385/1-59745-049-9:331

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-544-6

  • Online ISBN: 978-1-59745-049-2

  • eBook Packages: Springer Protocols

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