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.