Breakout Session G5 Advancements in Lung Recovery

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Breakout Session G-5Advancements in Lung
Recovery
Session Moderator Stacey Doll, OTBC Faculty
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Questions to Run On . . .

• What are the effective practices that result in
  high rates of lung transplantation?
• How will these practices impact the future of
  lung transplantation?
• What are the synergistic effects of a protocol
  for lung donor management?

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Where are we now?

• Cynthia S. Herrington, M.D.
• Surgical Director of Lung Transplantation
• University of Minnesota

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Where are we now?
YOU ARE HERE
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Where are we now?

• National forces changing the landscape of lung
  transplantation
• The allocation system 5/05
• The Organ Transplant Breakthrough Collaborative
  10/05

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Where are we now?
UNOS/OPTN
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Where are we now?
NOTE As of November 2, 2005, candidates with a
zero LAS have been screened from match runs.
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Where are we now?
NOTE As of November 2, 2005, candidates with a
zero LAS have been screened from match runs.
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Where are we now?
1478
UNOS/OPTN 6/06
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Where are we now?
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Where are we now?
330
150
115
UNOS/OPTN 6/06
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Where are we now?
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Where are we now?

• Positive changes in allocation and organ
  availability have led to an increased number of
  lung transplants
• Lung transplant programs need to adapt to take
  full advantage of this situation

Not to be an alarmist, butthe sky is falling
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Where are we now?

• Lung Problems Plague 9/11 Workers
• Study Nearly 70 Of Ground Zero Workers Had
  Respiratory Issues
• NEW YORK, Sept. 5, 2006
•  (CBS/AP)
• A QUOTE
• "I can understand the frustration and the anger,
  and most importantly, the concern about their
  future."
• Dr. John Howard,National Institute
  forOccupational Safety and Health

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Where are we now?

• Autopsy Links Cop's Death To 9/11 Dust
• 1st Known Ruling To Directly Link Death To Ground
  Zero Recovery Work
• NEW YORK, April 12, 2006 James Zadroga holding
  an oxygen tank in one hand and his daughter,
  Tylerann, in the other. (Zadroga Family)
• QUOTE
• "It is felt with a reasonable degree of medical
  certainty that the cause of death in this case
  was directly related to the 9/11 incident."
• Gerard Breton, pathologist

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What insights did you get from
this presentation?
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Donor Issues in Lung TransplantationOrgan
Transplantation Breakthrough Collaborative

• Luis Angel, MD
• Director of Lung Transplantation
• University of Texas Health Science Center
• October 19, 2006

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Donor Situation in our Program
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Proposed Changes to Our Transplant Program
Strict Listing Criteria
Early Donor Management
Extended Donors
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The San Antonio Lung Transplantation (SALT)
protocol

• Key components of the SALT protocol
• Improving communication between our transplant
  center and our local OPO
• Providing direct involvement and active
  management of donors by our lung transplant
  physicians
• Establishing a donor classification system after
  management of potential donors.

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Modified Criteria for Lung Donors

• PaO2/FIO2 of gt300 after recruitment, diuresis
• Chest radiograph
• Without infiltrates explained by atelectasis or
  minor contusion
• Clearly improving
• Bronchoscopy no evidence of copious purulent
  secretions or aspirated material

• Patients younger than 55 years,
• With accumulated smoking history of lt20pack years
• Without history of pulmonary diseases,
• Without significant chest trauma
• Peak pressure lt 30
• Negative gram stain

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Lung Donor Rate Time Series Analysis
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SALT Protocol Impact on Oxygenation
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SALT Protocol Potential to Actual Lung Donor
and Lung Transplants
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SALT Protocol Lung Transplant Outcomes by Donor
Type
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Survival by Donor Type
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Impact of Changes in the Program Waiting Time
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Challenges in Lung Donation

• Improve communication between transplant centers
  and organ banks
• Understand better the requirements of individual
  transplant centers
• Standardize a donor classification system
• Ideal, poor, extended, converted
• Increase the use of donor management strategies
  in every donor before running the match list
• Maintain ideal donors as ideal
• Convert poor donors
• Decrease the time from brain death pronunciation
  to procurement of organs

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What is working to achieve to these
results?
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Audience Participation. . .

• What are the effective practices that result in
  high rates of lung transplantation?
• How will these practices impact the future of
  lung transplantation?
• What are the synergistic effects of a protocol
  for lung donor management?