Selection and Management of the Donor

  • D. K. C. Cooper
  • I. L. Paradis


The importance of well-functioning donor organs cannot be overemphasized; it is crucial to the success of a heart or lung transplant procedure. Donor organ failure contributes towards a significant number of early deaths in thoracic organ transplant patients today, and is therefore an area where improvements can still be made. Careful selection and management of the potential donor therefore remain essential.


Brain Death Cardiac Allograft Donor Heart Heart Lung Transplant Carbon Monoxide Poisoning 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Schuler S, Warnecke H, Loebe M, Fleck E, Hetzer R. Extended donor age in cardiac transplantation. Circulation. 1989;80:133.Google Scholar
  2. 2.
    Mulvagh SL, Thornton B, Frazier OH et al. The older cardiac transplant donor. Relation to graft function and recipient survival longer than 6 years. Circulation. 1989;80:126.Google Scholar
  3. 3.
    Hosenpud JD, Novick RJ, Breen TJ, Keck B, Daily P. The Registry of the International Society for Heart and Lung Transplantation: Twelfth Official Report-1995. J Heart Lung Transplant. 1995;14:805.PubMedGoogle Scholar
  4. 4.
    Chan BBK, Fleischer KJ, Bergin JD et al. Weight is not an accurate criterion for adult cardiac transplant size matching. Ann Thorac Surg. 1991;52:1230.PubMedCrossRefGoogle Scholar
  5. 5.
    Blackbourne LH, Tribhle CG, Langenburg SE et al. Successful use of undersized donors for orthotopic heart transplantation-with a caveat. Ann Thorac Surg. 1994;57:1472.PubMedCrossRefGoogle Scholar
  6. 6.
    Sethi GK, Lanauze P, Rosado LJ el al. Clinical significance of weight difference between donor and recipient in heart transplantation. J Thorac Cardiovasc Surg. 1993;106:444.PubMedGoogle Scholar
  7. 7.
    Costanzo-Nordin MR, Liao Y, Grusk BB et al. Oversizing of donor hearts: beneficial or detrimental? J Heart Lung Transplant. 1991;10:717.PubMedGoogle Scholar
  8. 8.
    Yeoh TK, Frist WH, Lagerstrom C et al. Relationship of cardiac allograft size and pulmonary vascular resistance to long-term cardiopulmonary function. J Heart Lung Transplant. 1992;11:1168.PubMedGoogle Scholar
  9. 9.
    Hosenpud JD, Pantely GA, Morton MJ et al. Relation between recipient: donor body size match and hemodynamics three months after transplantation. J Heart Transplant. 1989;8:241.PubMedGoogle Scholar
  10. 10.
    Haverich A, Novitzky D, Cooper DKC. Transplantation of the heart and both lungs: selection of the donor: excision and storage of donor organs. In: Cooper DKC, Novitzky, D, editors. The transplantation and replacement of thoracic organs, 1st edn. London: Kluwer; 1990:273.Google Scholar
  11. 11.
    Noirclerc M, Shennib H, Guidicelli R et al. Size matching in lung transplantation. J Heart Lung Transplant. 1992;11:S203.PubMedGoogle Scholar
  12. 12.
    Bethune DW, Wheeldon DR. Transplantation of the heart and both lungs: anesthetic management. In; Cooper DKC, Novitzky D, editors. The transplantation and replacement of thoracic organs, 1st edn. London: Kluwer; 1990:283.Google Scholar
  13. 13.
    Higenbottam TW, Wallwork J. Transplantation of the heart and both lungs: postoperative management, surgical complications, diagnosis and management of acute rejection. In: Cooper DKC, Novitzky D, editors. The transplantation and replacement of thoracic organs, 1st edn. London: Kluwer; 1990:299.Google Scholar
  14. 14.
    Cotes, JE. In: Lung Function, 4th edn. Oxford: Blackwell Scientific Publications; 1979:386.Google Scholar
  15. 15.
    Sundaresan S, Trachiotis GD, Aoe M, Patterson GA, Cooper JD. Donor lung procurement: assessment and operative technique. Ann Thorac Surg. 1993;56:1409.PubMedCrossRefGoogle Scholar
  16. 16.
    Cooper DKC. A clinical survey of cardiac transplantation between ABO-blood group incompatible recipient and donors. J Heart Transplant. (In press).Google Scholar
  17. 17.
    Nakatani T, Aida H, Macris MP, Frazier OH. Effect of ABO blood type on survival of CSA-treated cardiac transplant patients. J Heart Transplant. 1988;7:81 (abstract).Google Scholar
  18. 18.
    Gilbert EM, Krueger SK, Murray JL et al. Echocardiographic evaluation of potential cardiac transplant donors. J Thorac Cardiovasc Surg. 1988;95:1003.PubMedGoogle Scholar
  19. 19.
    Fentz V, Gormsen J. Electrocardiographic patterns in patients with cerehrovascular accidents. Circulation. 1962;25:22.PubMedGoogle Scholar
  20. 20.
    Cooper DKC. The donor heart: the present position with regard to resuscitation, storage, and assessment of viability. J Surg Res. 1976;21:363.PubMedCrossRefGoogle Scholar
  21. 21.
    Baldwin JC, Anderson JL, Boucek MM et al. Task force II: Donor guidelines. Twenty-fourth Bethesda Conference on Cardiac Transplantation. J Am Coll Cardiol. 1993;22:15.PubMedCrossRefGoogle Scholar
  22. 22.
    Kron IL, Tribble CG, Kern JA et al. Successful transplantation of marginally acceptable thoracic organs. Ann Thorac Surg. 1993;217:518.Google Scholar
  23. 23.
    Yokoyama Y, Cooper DKC, Sasaki H et al. Donor-heart evaluation by monitoring the left ventricular pressure-volume relationship: clinical observations. J Heart Lung Transplant. 1992;11:685.PubMedGoogle Scholar
  24. 24.
    Guest TM, Ramanathan AV, Tuteur PG et al. Myocardial injury in critically ill patients. A frequently unrecognized complication. J Am Med Assoc. 1995;273:1945.CrossRefGoogle Scholar
  25. 25.
    Laks H, Gates RN, Ardehali A et al. Orthotopic heart transplantation and concurrent coronary bypass. J Heart Lung Transplant. 1993;12:810.PubMedGoogle Scholar
  26. 26.
    Corris PA, Dark JH. Aetiology of asthma: lessons from lung transplantation. Lancet. 1993;341:1369.PubMedCrossRefGoogle Scholar
  27. 27.
    Jamieson SW, Baldwin J, Stinson EB et al. Clinical heart-lung transplantation. Transplantation. 1984;37:81.PubMedCrossRefGoogle Scholar
  28. 28.
    Painvin GA, Recce IJ, Cooley DA, Frazicr OH. Cardiopulmonary allotransplantation, a collective review: experimental progress and current clinical status. Tex Heart Inst J. 1983;10:371.PubMedGoogle Scholar
  29. 29.
    Zenati M, Dowling RD, Armitage JM et al. Organ procurement for pulmonary transplantation. Ann Thorac Surg. 1989;48:882.PubMedCrossRefGoogle Scholar
  30. 30.
    Zenati M, Dowling RD, Dummer JS et al. Influence of the donor lung on development of early infections in lung transplant recipients. J Heart Transplant. 1990;9:502.PubMedGoogle Scholar
  31. 31.
    Ciulli F, Tamm M, Dennis C et al. Donor-transmitted bacterial infection in heartlung transplantation. Transplant Proc. 1993;25:1155.PubMedGoogle Scholar
  32. 32.
    Riou B, Guesde R, Jacquens Y et al. Fiberoptic bronchoscopy in brain-dead organ donors. Am J Respir Crit Care Med. 1994;150:558.PubMedGoogle Scholar
  33. 33.
    Sundaresan S, Semenkovich J, Ochoa L et al. Successful outcome of lung transplantation is not compromised by the use of marginal donor lungs. J Thorac Cardiovasc Surg. 1995;109:1075.PubMedCrossRefGoogle Scholar
  34. 34.
    Low DE, Kaiser LR, Haydock DA, Trulock E, Cooper JD. The donor lung; infectious and pathologic factors affecting the outcome in lung transplantation. J Thorac Cardiovasc Surg. 1993;106:614.PubMedGoogle Scholar
  35. 35.
    Dowling RD, Zenati M, Yousem SA et al. Donor-transmitted pneumonia in experimental lung allografts. J Thorac Cardiovasc Surg. 1992;103:767.PubMedGoogle Scholar
  36. 36.
    Anthuber M, Sudhoff F, Schuetz A, Kemkes BM. Donor-transmitted infections in heart transplantation-HIV, CMV, and toxoplasmosis. Transplant Proc. 1991;23:2634.PubMedGoogle Scholar
  37. 37.
    Rubin RH, Jenkins RL, Shaw BW et al. The acquired immunodeficiency syndrome and transplantation. Transplantation. 1987;44:1.PubMedCrossRefGoogle Scholar
  38. 38.
    L’Age-Stehr J, Schwarz A, Offermann G et al. HTLV-III infection in kidney transplant recipients. Lancet. 1985;2:1361.CrossRefGoogle Scholar
  39. 39.
    Prompt CA, Reis MM, Grillo FM et al. Transmission of AIDS virus at renal transplantation. Lancet. 1985;2:672.PubMedCrossRefGoogle Scholar
  40. 40.
    Schwarz A, Hoffman F, L’Age-Stehr J, Tegzess AM, Offermann G. Human immunodeficiency virus transmission by organ donation. Transplantation. 1987;44:21.PubMedCrossRefGoogle Scholar
  41. 41.
    Tzakis AG, Cooper MH, Dummer JS et al. Transplantation in HIV+ patients. Transplantation. 1990;49:354.PubMedCrossRefGoogle Scholar
  42. 42.
    Simouds RJ, Holmberg SD, Hurwitz RL el al. Transmission of human immunodeficiency virus type I from a seronegative organ and tissue donor. N Engl J Med. 1992;326:726.CrossRefGoogle Scholar
  43. 43.
    Pereira BJG, Milford EL, Kirkman RL et al. Prevalence of hepatitis C virus RNA in organ donors positive for hepatitis antibody and in the recipients of their organs. N Engl J Med. 1992;327:910.PubMedCrossRefGoogle Scholar
  44. 44.
    Milfred SK, Lake KD, Anderson DJ et al. Practices of cardiothoracic transplant centers regarding hepatitis C-seropositive candidates and donors. Transplantation. 1994;57:568.PubMedCrossRefGoogle Scholar
  45. 45.
    Rose AG, Uys CJ, Novitzky D, Cooper DKC, Barnard CN. Toxoplasmosis of donor and recipient hearts after heterotopic cardiac transplantation. Arch Pathol Lab Med. 1983;107:368.PubMedGoogle Scholar
  46. 46.
    Minor RL, Scott BD, Brown DD, Winniford MD. Cocaine-induced myocardial infarction in patients with normal coronary arteries. Ann Intern Med. 1991;115:797.PubMedGoogle Scholar
  47. 47.
    Chakko S, Fernandez A, Mellman TA et al. Cardiac manifestations of cocaine abuse: a cross-sectional study of asymptomatic men with a history of long-term abuse of ‘crack’ cocaine. J Am Coll Cardiol. 1992;20:1168.PubMedCrossRefGoogle Scholar
  48. 48.
    Warner EA. Cocaine abuse. Ann Intern Med. 1993;119:226.PubMedGoogle Scholar
  49. 49.
    Freimark D, Czer LSC, Admon D et al. Donors with a history of cocaine use: effect of survival and rejection frequency after heart transplantation. J Heart Lung Transplant. 1994;13:1138.PubMedGoogle Scholar
  50. 50.
    Houyel L, Petit J, Nottin R et al. Adult heart transplantation: adverse role of chronicalcoholism in donors on early graft function. J Heart Lung Transplant. 1992;11:1184.PubMedGoogle Scholar
  51. 51.
    Hantson P, Vekemans M-C, Squilflet J-P, Mahieu P. Outcome following organ removal from poisoned donors; experience with 12 cases and a review of the literature. Transplant Int. 1995;8:185.CrossRefGoogle Scholar
  52. 52.
    Barkoukis TJ, Sarbak CA, Lewis D, Whittier FC. Multiorgan procurement from a victim of cyanide poisoning. A case report and review of the literature. Transplantation. 1993;55:1434.PubMedCrossRefGoogle Scholar
  53. 53.
    Thorn SR, Keim LW. Carbon monoxide poisoning: a review of epidemiology, pathophysiology, clinical findings and treatment options, including hyperbaric oxygen therapy. J Toxicol Clin. 1989;27:141.Google Scholar
  54. 54.
    Smith JA, Bergin PJ, Williams TJ, Esmore DS. Successful heart transplantation with cardiac allografts exposed to carbon monoxide poisoning. J Heart Lung Transplant. 1992;11:698.PubMedGoogle Scholar
  55. 55.
    Iberer F, Konigsminer A, Wasler A et al. Cardiac allograft harvesting after carbon monoxide poisoning. Report of a successful orthotopic heart transplantation. J Heart Lung Transplant. 1993; 12:499.PubMedGoogle Scholar
  56. 56.
    Shennib H, Adoumie R, Fraser R. Successful transplantation of a lung allograft from a carbon monoxide poisoning victim. J Heart Lung Transplant. 1992;11:68.PubMedGoogle Scholar
  57. 57.
    Glanville AR, Marshman D, Keogh A et al. Outcome in paired recipients of single lung transplants from the same donor. J Heart Lung Transplant. 1995;14:878.PubMedGoogle Scholar
  58. 58.
    Young JB, Naftel DC, Bourge RC et al. Matching the heart donor and heart transplant recipient. Clues for successful expansion of the donor pool: a multivariable, multiinstitutional report. J Heart Lung Transplant. 1994;13:353.PubMedGoogle Scholar
  59. 59.
    Burch GE, Meyer R, Abildskov J. A new electrocardiographic pattern observed in cerebrovascular accidents. Circulation. 1954;9:719.PubMedGoogle Scholar
  60. 60.
    De Pasquale NP, Burch GE. How normal is the donor heart? Am Heart J. 1969;77:719.CrossRefGoogle Scholar
  61. 61.
    Greenhoot AH, Reichenbach DD. Cardiac injury and subarachnoid hemorrhage. J Neurosurg. 1969;30:521.PubMedCrossRefGoogle Scholar
  62. 62.
    Heggtveit HA. The donor heart; brain death and pathological changes in the heart. Laval Med. 1970;41:178.PubMedGoogle Scholar
  63. 63.
    Smith RP, Tomlinson BE. Subendocardial haemorrhages associated with intracranial lesions. J Pathol Bacteriol. 1954;68:327.PubMedCrossRefGoogle Scholar
  64. 64.
    Lundsgaard-Hansen P, Schill W, Heitmann L et al. Influence of the agonal period on the postmortem metabolic state of the heart: a problem in cardiac preservation. Ann Surg. 1971;174:744.PubMedCrossRefGoogle Scholar
  65. 65.
    Cooper DKC. Resuscitation of the cadaver donor heart in the dog. III. The influence of the agonal period on the success of resuscitation. Guys Hosp Rep. 1974;123:363.Google Scholar
  66. 66.
    Cooper DKC. Transplantation using donor hearts from patients with circulatory arrest. (Letter). Ann Thorac Surg. 1993;55:811.PubMedCrossRefGoogle Scholar
  67. 67.
    Cooper DKC, Novitzky D, Zuhdi N. Hormonal therapy-a new concept in the management of organ donors. Transplant Proc. 1988;20:1.Google Scholar
  68. 68.
    Cooper DKC, Novitzky D, Wicomb WN. The pathophysiological effects of brain death on potential donor organs, with particular reference to the heart. Ann R Coll Surg Engl. 1989;71:261.PubMedGoogle Scholar
  69. 69.
    Novitzky D, Wicomb WN, Cooper DKC et al. Electrocardiographic, haemodynamic and endocrine changes occurring during experimental brain death in the Chacma baboon. J Heart Transplant. 1984;4:63.Google Scholar
  70. 70.
    Wicomb WN, Cooper DKC, Lanza RP, Novitzky D, Isaacs S. The effects of brain death and 24 hours storage by hypothermic perfusion on donor heart function in the pig. J Thorac Cardiovasc Surg. 1986;91:896.PubMedGoogle Scholar
  71. 71.
    Novitzky D, Wicomb WN, Cooper DKC, Rose AG, Reichart B. Prevention of myocardial injury during brain death by total cardiac sympathectomy in the Chacma baboon. Ann Thorac Surg. 1986;41:520.PubMedCrossRefGoogle Scholar
  72. 72.
    Novitzky D, Wicomb WN, Rose AG, Cooper DKC, Reichart B. Pathophysiology of pulmonary edema following experimental brain death in the Chacma baboon. Ann Thorac Surg. 1987;43:288.PubMedCrossRefGoogle Scholar
  73. 73.
    Novitzky D, Cooper DKC, Rose AG et al. Early donor heart failure following transplantation-the possible role of myocardial injury sustained during brain death. Clin Transplant. 1987;1:108.Google Scholar
  74. 74.
    Novitzky D, Cooper DKC, Rose AG, Reichart B. Prevention of myocardial injury by pre-treatment with verapamil hydrochloride following experimental brain death; efficacy in a baboon model. Am J Emerg Med. 1987;15:11.CrossRefGoogle Scholar
  75. 75.
    Novitzky D, Cooper DKC, Morrell D, Isaacs S. Change from aerobic to anaerobic metabolism after brain death, and reversal following triiodothyroninc (T3) therapy. Transplantation. 1988;45:32.PubMedCrossRefGoogle Scholar
  76. 76.
    Novitzky D, Rose AG, Cooper DKC. Injury of myocardial conduction tissue and coronary artery smooth muscle following brain death in the baboon. Transplantation. 1988;45:964.PubMedCrossRefGoogle Scholar
  77. 77.
    Novitzky D, Cooper DKC, Reichart B. Haemodynamic and metabolic responses to hormonal therapy in brain-dead potential organ donors. Transplantation. 1987;43:852.PubMedGoogle Scholar
  78. 78.
    Taniguchi S, Cooper DKC. The potential role of thyroid hormone substitute in cardiac surgery and transplantation. Asia Pacific J Thorac Cardiovasc Surg. (In press).Google Scholar
  79. 79.
    Novitzky D, Wicomb WN, Cooper DKC, Tjaalgard MA. Improved cardiac function following hormonal therapy in brain-dead pigs: relevance to organ donation. Cryobiology. 1987;24:1.PubMedCrossRefGoogle Scholar
  80. 80.
    Wicomb WN, Cooper DKC, Novitzky D. Impairment of renal slice function following brain death, with reversibility of injury by hormonal therapy. Transplantation. 1986;41:29.PubMedCrossRefGoogle Scholar
  81. 81.
    Depret J, Teboul J-L, Benoit G, Mercat A, Richard C. Global energetic failure in brain-dead patients. Transplantation. 1995;60:966.PubMedCrossRefGoogle Scholar
  82. 82.
    Wheeldon DR, Potter CDO, Dunning J et al. Haemodynamic correction in multiorgan donation. Lancet. 1992;339:1175.PubMedCrossRefGoogle Scholar
  83. 83.
    Wheeldon DR, Potter CDO, Oduro A, Wallwork J, Large SR. Donor management and organ distribution. Transforming the ‘unacceptable’ donor: outcomes from the adoption of a standardized donor management technique. J Heart Lung Transplant. 1995;14:734.PubMedGoogle Scholar
  84. 84.
    Winton TL, Miller JD, Scavuzzo M et al. Donor selection for pulmonary transplantation. Transplant Proc. 1991;23:2472.PubMedGoogle Scholar
  85. 85.
    Richardson DW, Robinson AG. Desmopressin. Ann Intern Med. 1985;103:228.PubMedGoogle Scholar
  86. 86.
    Debelak L, Pollak R, Reckard C, Arginine vasopressin versus desmopressin for the treatment of diabetes insipidus in the brain dead organ donor. Transplant Proc. 1990;22:351.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • D. K. C. Cooper
  • I. L. Paradis

There are no affiliations available

Personalised recommendations