Hemoadsorption to Improve Organ Recovery from Brain-Dead Organ Donors: A Novel Therapy for a Novel Indication?

Cytokine mass balance levels in donation after circulatory death donors using hemoadsorption: Case series report

The use of hemadsorption has been purposed to reduce cytokine levels during the reperfusion phase during donation after circulatory death (DCD) programs. This paper aims to describe a cases series of the inflammatory cytokine levels before and after hemadsorption during normothermic reperfusion in DCD donors of liver and kidneys. In this observational pilot paper, we describe 8 DCD donors of liver or kidneys in our center from the year 2018 to 2019. All DCD donor subjects had similar age, were younger than 60 years, without evident critical conditions, no liver or kidney dysfunction known, and they presented with poor neurological outcomes instrumentally and clinically documented. We observed in our patients an interesting reduction of IL-10 and TNF-α levels during the normothermic reperfusion with hemadsorption. We transplanted all livers and kidneys from DCD donors without significant compliances.

Rationale of Blood Purification in the Post-Resuscitation Syndrome following Out-of-Hospital Cardiac Arrest: A Narrative Review

Even today, little is known about the pathophysiology of the post-resuscitation syndrome. Our narrative review is one of the first summarizing all the knowledge about this phenomenon. We have focused our review upon the potential role of blood purification in attenuating the consequences of the post-resuscitation syndrome. Blood purification can decrease the cytokine storm particularly when using a CytoSorb absorber. Acrylonitrile 69-based oXiris membranes can remove endotoxin and high-mobility group box 1 protein. Blood purification techniques can quickly induce hypothermia. Blood purification can be used with veno-arterial extracorporeal membrane oxygenation to remove excess water. Further trials are needed to provide more concrete data about the use of blood purification in the post-resuscitation syndrome.

Effects of brain death on organ quality and transplant outcome

The inferiority of organs from brain dead donors is reflected by impaired graft survival and patient outcome. Brain death effects hemodynamic stability, hormonal changes, and neuroimmunologic effects and unleashes a cascade of inflammatory events. Despite considerable efforts in experimental and clinical research, most of the mechanisms linked to brain death are only appreciated on a descriptive level. This overview presents our current understanding of the pathophysiology and consequences of brain death on organ injury and summarizes available therapeutic interventions.

Hospital-independent organ recovery from deceased donors: a two-year experience

Early experience with deceased donor (DD) organ recovery outside of the hospital setting was found to be safe, efficient and cost effective. A 2-year experience under current practice protocols implemented to further process improvements is now reviewed. From December 1, 2001 to December 31, 2003, 123 criteria eligible DDs were transferred from local and regional hospitals to the Mid-America Transplant Services (MTS) facility for organ and tissue recovery. In this retrospective analysis, outcome comparisons were made with 79 conventional hospital-based recoveries. Compared to hospital recoveries, MTS facility recoveries were associated with significantly reduced critical care unit time (819 vs. 502 min), time to cross-clamp following brain death (966 vs. 731 min), operating room delay (54 vs. 9 min) and a trend toward reduced organ cold ischemia times which reached significance for heart and lungs when compared to regional hospital recoveries (147 vs. 221 and 192 vs. 327 min). MTS facility recovery afforded substantial cost savings over local and regional hospital recoveries (US 6,690 dollars and US 5,452 dollars per donor, respectively). The current practice of DD recovery at the MTS facility was applicable for most recoveries, improved process efficiency, and afforded substantial cost savings without donor compromise.