Selective Pneumoplegia Delivery System Facilitating Procurement in Donors After Circulatory Death

Purpose

Donation after circulatory death (DCD Maastricht III) increases the donor pool, but the induction of organ preservation solutions necessitates a staged approach. As the heart has a low ischemic tolerance it is vital in a DCD retrieval to reanimate the heart quickly without waiting for pneumoplegia to finish. We have devised a selective pneumoplegia delivery system to aid independent lung procurement from the heart to reduce ischemic times.

Methods

Figure 1 shows the customized pneumoplegia delivery system. It consists of two self-inflated soft balloon retrograde cardioplegia cannulae connected with a ¼ inch y-connector and ¼ inch silicone tubes. During cardioplegia the pulmonary artery is transacted, the cannulae inserted into the right and left pulmonary arteries to deliver simultaneous selective antegrade pneumoplegia (Figure 2). After cardioplegia, the heart procurement and its reanimation on the organ care system can commence as the pneumoplegia is running. The self-inflated balloons of the cannulae do not require manual fixation, saving time as there are several litres of pneumoplegia. The same cannulae may be used to deliver the retrograde pneumoplegia.

Results

Between 2019-21 we performed three such procurements, with good immediate outcomes in all lung transplant recipients.

Conclusion

Our customized system allows simultaneous delivery of selective antegrade and retrograde pneumoplegia during and after cardiectomy in a DCD retrieval. This may reduce ischaemia for the heart and lung and improve organ utilisation. More studies are required to assess the potential benefit of our pneumoplegia delivery system.