Wait and treat: a new approach to DBD donor with stunned heart F. Procaccio, M. Liviero Casartelli, D Simion Neuro Intensive Care Unit University City Hospital Verona - Italy

Rush and retrieve after BD More Time is less Function for the graft “Classical” approach to (unstable) donors to (unstable) donors

Why in DBD donors the functionality of organs is often severely decresed ? These organs are considered not suitable and not utilized.

Myocytolisis Contraction band lesions Inflammation The Adrenergic Storm Catecholamine induced cardiac injury normal Reversible ! Echocardiographic dysfunction in 42% BD Dujardin et al. J Heart Lung Transplant, 2001

Verona protocol 2010 Verona protocol 2010 Key points: Fluid Volume wise Replacement Fluid Volume wise Replacement Cathecolamines sparing strategy by Early Primary HT: T3 - V - Insuline - Methylprednisolone Cathecolamines sparing strategy by Early Primary HT: T3 - V - Insuline - Methylprednisolone Serial Echo + Troponine + PCT Serial Echo + Troponine + PCT Prospective clinical study

52Baseline+ 4 hr Echo 19/52 initial sub-normal 53% improved Hormonal Therapy Did not affect LV function.

Extimated EF 35%; trop 0,2Extimated EF 56%; trop 0,2 Brain Death 48 hours HT ECHOCARDIOGRAPHIC PATTERNS -2 Woman 46 years old, trauma, heart donor  heart transplanted and well working heart transplanted and well working Verona Neuro ICU, Simion et al., 2010

MAP CI SVR HT HT HT HT Taniguchi, 1992

PHDSexAge Early LVEF % Final LVEF % Peak Troponin ng/mL Final Troponin ng/mL MhMh T3 h NE hOutcomeHeartDonor Other Organs 1 M3260 0,470, Donor Yes2L-2K-Li 2 F5460 3,270, Donor Yes2K 3 F , Donor Altered CGF 2K-Li 4 M5155 0,990, Donor Altered CGF 2K-Li 5 M ,700, O pposition -- 6 M Donor Yes2L-2K-Li-P 7 F ,230,214890Donor Yes2K-Li 8 F5660 5,610, Donor Yes2K 9 M ,350, O pposition M ,900, O pposition F , Donor Yes2L-2K-Li 12 F ,800, TBC F ,380, Donor Yes2K 14 M ,320,304230Malignancy F ,402, Donor Yes2K-Li 15 Heart potential Donors out of 27 BD Organ Potential Donors Neuro ICU – Verona 2010 Hours of treatment after BD

HeartRecovering Storm Harvesting Days 1 HT

... no rush but rather an improved donor management prior to retrieval prior to retrieval will benefit donor kidney viability.

Brain Death is a severe illness for the organs but reversible and treatable in ICU

Treating organs in the Donor before harvesting (and out of the Donor before trasplantation) (ex vivo) can improve function in Recipients. Treat and Wait Treating organs in the Donor before harvesting (and out of the Donor before trasplantation) (ex vivo) can improve function in Recipients. …… to be proved by evidence

Can we wait and facilitate organ recovery? To prevent the early graft failure …… to be proved by evidence Treat and Wait