1. 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

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

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

4. 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

6. 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

7. 52Baseline+ 4 hr Echo 19/52 initial sub-normal 53% improved Hormonal Therapy Did not affect LV function.

8. 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

9. MAP CI SVR HT HT HT HT Taniguchi, 1992

10. PHDSexAge Early LVEF % Final LVEF % Peak Troponin ng/mL Final Troponin ng/mL MhMh T3 h NE hOutcomeHeartDonor Other Organs 1 M3260 0,470,2651150Donor Yes2L-2K-Li 2 F5460 3,270,5030150Donor Yes2K 3 F6454600,01 4890Donor Altered CGF 2K-Li 4 M5155 0,990,6430120Donor Altered CGF 2K-Li 5 M2060672,700,3036330 O pposition -- 6 M485560--39276Donor Yes2L-2K-Li-P 7 F4537550,230,214890Donor Yes2K-Li 8 F5660 5,610,2572630Donor Yes2K 9 M6643604,350,059030 O pposition -- 10 M1642600,900,081141812 O pposition -- 11 F6447602,17-692712Donor Yes2L-2K-Li 12 F56205413,800,9048120TBC -- 13 F4623600,380,17156213Donor Yes2K 14 M5044581,320,304230Malignancy -- 15 F5160 11,402,1533240Donor Yes2K-Li 15 Heart potential Donors out of 27 BD Organ Potential Donors Neuro ICU – Verona 2010 Hours of treatment after BD

11. HeartRecovering Storm Harvesting Days 1 HT

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

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

14. 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

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