INTRODUCTION
Lung transplantation is an effective therapy for patients with end-stage
lung disease.1 However, donor availability and donor
organ quality continue to be critical challenges to lung
transplantation. More than 80% of donor lungs are potentially injured
or infected and are considered unsuitable for
transplantation.2 Significant improvements in patient
outcomes have been made related to changes in donor selection, organ
preservation, perioperative management, and better treatment of
postoperative complications.3 Ex vivo lung perfusion
(EVLP) is a significant advancement in donor lung preservation that can
expand the number of lungs available for transplantation and decrease
the waiting time for recipients.4,5 The Organ Care
System (OCS) (TransMedics, Andover, MA) is one type of revolutionary
EVLP technology that can expand the organ retrieval range. The OCS Lung
is currently the only United States Food and Drug
Administration-approved, portable, normothermic lung perfusion system
used to recover standard and expanded criteria donor
lungs.6-8
Current EVLP systems use a variety of perfusates.9,10OCS Lung uses packed red blood cells (pRBC) diluted in OCS Lung
solution. OCS Lung solution is a high oncotic, colloid-based
extracellular low potassium solution. The use of pRBC is a logical
choice compared to whole blood as it limits viscosity, maximizes
availability, and reduces interference with other transplant
teams.9 When selecting a cooler to transport pRBC
units for OCS Lung recoveries, several factors were important. The ideal
transport cooler would be durable, lightweight, offer easy and quick
conditioning, and maintain the 1 to 6 °C storage temperature required by
the Association for the Advancement of Blood & Biotherapies Standards
for a long duration. Prehospital programs have widely utilized thermal
control technology for helicopter emergency medical
services.11-13 Compared to passive refrigeration,
thermal control technology has also been used to transport
temperature-sensitive medications.14,15 However,
thermal control technology in conjunction with EVLP has not been
researched. With an increase in the utilization of EVLP (over greater
distances), viable blood storage and transportation solutions will
become an essential component of EVLP lung recovery.
We describe the processes and standard work governing safe storage,
transportation, and stewardship of blood products within an OCS Lung
program and review quality improvement data from all recoveries
examining usage, demographics, and outcomes.