RU2441608C1 - Method for restoration and maintenance of vitality of an ischemically damaged donor organ - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention is referred to the area of medicine, namely to transplantology and can be used for restoration and maintenance of vitality of an ischemically damaged donor organ. Before explantation of organ from donor body for 2-3 hours the normothermic perfusion of abdominal blood supply regions is performed using pulsating flow of oxygen enriched perfusate on the basis of blood, from which the activated leucocytes and underoxidized products of biochemical decay are removed additionally. The explantation of organ out of donor's body is performed. The normothermic perfusion of isolated organ is performed. During the organ perfusion process the estimation of its viability for transplantation is performed. The initial systolic pressure is established as 35 mm Hg in case of optimal implant state, 40-45 mm Hg for implants with borderline ischemic damage. Then the estimation is performed for degree of opening of circulatory bed of an organ by alteration of resistive index value. If within the period of 4-6 hours the resistive index does not increase or decrease the organ is presumed not viable for transplantation. If within this time the value of resistive index decreases by 2-3 fold and the flow speed is established within 80-150 ml/min the perfusion is continued till the moment of donor organ transplantation. ^ EFFECT: restoration of vitality of donor organs with borderline characteristics; clear estimation of its viability for transplantation and long-time maintenance of functional state of a transplantation viable organ. ^ 1 dwg, 2 dwg, 2 ex

Description

The invention relates to medical equipment and can be used in transplantology.

Typically, organ donors are patients with severe trauma or brain disease, resulting in brain death and death of the patient. Organ harvesting is carried out only in special conditions under which blood circulation and artificial respiration of the deceased patient are maintained, which leads to a shortage of donor organs.

Donor organs are not explanted in patients who suddenly die, because hypoxia and ischemia occur after disruption of blood circulation, leading to the disintegration of organs and tissues.

At the same time, the use of perfusion devices is a proven opportunity to restore the viability of donor organs, allowing you to use the unrealized potential of donors with irreversible cardiac arrest.

A known method of artificially maintaining blood circulation and gas exchange in the organs of a donor before they are explanted using a cardiopulmonary bypass device in conditions of deep hypothermia with autologous blood [Gomez M., Alvarez J., Arias J., et al. Cardiopulmonary bypass and profound hypothermia as a means for obtaining kidney grafts from irreversible cardiac arrest donors: Cooling technique // Transplant. Proc. - 1993 .-- Vol.25. - P.1501-1503].

The method consists in the fact that the blood from the vascular bed is evacuated, cooled, oxygenated and returned back, repeating this operation cyclically and reproducing, thereby, the function of a non-functioning cardiovascular system.

The disadvantage of this method is that activated leukocytes are not removed from the perfusion circuit, which make the main contribution to the damage to the tissue of donor organs both through the isolation of proteological enzymes and through the obstructive component, obstructing the lumen of the capillaries, leading to the binding of platelets, red blood cells, worsening the functional state donor organs and, thereby, reducing their viability.

Another disadvantage of this method is that perfusion is carried out under hypothermia, which does not allow to affect the functional state and restore the viability of ischemic damaged organs.

Another disadvantage is the lack of hardware perfusion of an ischemic damaged organ after removal, which reduces the shelf life of the organ and eliminates the possibility of restoring viability and affecting the functional state of the organ before transplantation.

A known method and device for perfusion of an isolated organ according to USSR author's certificate No. 1687262, IPC A01N 1/00, publication October 30, 1991. The device contains a perfusion chamber with physiological saline, into which an isolated organ (spleen) is placed, and a working chamber with heated water between a source of pulsating pressure, made in the form of an elastic chamber, and a flexible restrictive plate. By adjusting the water level in the working chamber, the pressure on the isolated organ is set, and by supplying air to the working chamber, a pulsating effect is transmitted to the organ.

The disadvantage of this method is that it does not purify the vascular system of an organ, which is necessary to restore blood supply and maintain viability of the organ.

The closest analogue adopted for the prototype of the proposed method is the method of preservation of organs, limbs and tissue flaps according to the patent of the Russian Federation No. 21394962 for the invention, IPC A01N 1/02, publication of August 27, 1999.

According to the prototype, after explantation, the donor organ is placed in an organ storage chamber, to which the arteries of the perfusion device having three circulation circuits are connected.

The first circuit connected to the organ artery, using the first peristaltic pump, supplies the organ with a perfused solution, oxygenated and purified by means of a hemofilter.

The second circuit contains a reservoir of nutrient solution, the inputs of which are connected to the outputs of the venous outflows of the chamber, and the output is connected to the input of the second peristaltic pump, the output of which is connected through the hemofilter to the input of the perfusion pump of the first circulation circuit. In the hemofilter, detoxification of the venous perfusate, exchange of metabolites, and enrichment with oxygen, which is transmitted to the first circuit in the liquid phase from the circulating dilution circuit connected to the oxygen source, are performed.

The third circuit of the perfusion device is intended for periodic washing of the organ with physiological aqueous solution.

The perfusion parameters are set using the electronic control unit. Pressure is measured in the highways of the first and second circuits, and an air trap is installed in front of the arterial inflow of the organ storage chamber to prevent air bubbles from entering the circulatory system.

Perfusion is carried out in normothermic conditions (at room temperature or body temperature). An aqueous nutrient solution, blood or blood product is used as perfusion solution.

The advantage of the prototype is the ability to maintain metabolism and preserve the activity of fibroblasts for wound healing and healing of the organ, which allows to extend the shelf life of the organ.

The disadvantage of the prototype is that it is designed to maintain the viability of organs removed from the body of the donor immediately after his death.

In normal practice, after the death of a patient has been ascertained, it takes a considerable amount of time to document the permission to remove an organ during which ischemic damage to the organs occurs.

In addition, the method does not provide for the removal of activated leukocytes from the perfusate, which creates the prerequisites for the development of severe reperfusion complications after transplantation of these organs.

The objective of the invention is to increase the recovery and maintenance of the viability of ischemic damaged donor organs.

Achieving the claimed result is achieved by phased restoration of organ viability: first, before explantation, normothermal perfusion of the abdominal region in the donor’s body is performed, and then after explantation, continuous normothermic perfusion of the isolated organ is performed with simultaneous assessment of the organ’s suitability for transplantation, using a modified solution for perfusion at both stages based on autologous blood.

It is a two-stage perfusion that allows not only to increase the shelf life of donor organs, but first to rehabilitate and restore the functional reserve of organs that were previously considered unsuitable for transplantation due to ischemic injuries that occur after the deceased's blood circulation (asystolic donors), or due to concomitant diseases of the deceased (donors with advanced criteria).

The essence of the invention lies in the fact that in a method of restoring and maintaining the viability of an ischemic damaged donor organ, including explanting an organ from a donor’s body and conducting normothermic perfusion of an isolated organ with a pulsating flow of blood-based oxygen-enriched perfusate, a normothermic is carried out for 2-3 hours before explanting the organ perfusion of the abdominal blood supply region in the body of the donor with a pulsating flow of oxygen-enriched blood-based perfusate, from then the activated leukocytes and underoxidized products of biochemical decay are completely removed, then the organ is explanted and, during normothermic perfusion of the isolated organ, its suitability for transplantation is assessed, while in the case of an optimal implant condition, the initial systolic pressure is set to 35 mmHg, and for implants with borderline ischemic lesions, the initial systolic is set in the range of 40-45 mm Hg, and then the degree of disclosure is circulated channel of the organ for changing the value of the resistive index, and if within 4-6 hours the value of the resistive index does not decrease or increases, the organ is deemed unsuitable for transplantation, and if during this time the value of the resistive index decreases by 2-3 times and the flow rate is set within 80-150 ml / min, perfusion is continued until the organ is transplanted.

In addition, the perfusate in a volume of 4-4.5 l contains

preservative solution - 1.5-2 l,

perfluoran - 400-600 ml,

heparin - 50,000 IU,

streptokinase -1.5 million units,

solomedrol - 300 mcg,

isoptin - 5 mg,

nitroglycerin - 5 mg,

autoblood - the rest.

In addition, if it is necessary to transport an organ to another medical institution, the organ storage chamber is placed in a refrigerated transport container, and during transportation, perfusion with a preservation solution is performed at a temperature of 4-7 ° C.

The invention is illustrated by drawings, on which:

figure 1 - device for perfusion of the abdominal region of blood supply in the body of the donor;

figure 2 - device for perfusion of an isolated organ.

Figure 1 marked

1 - venous reservoir;

2 - mechatronic perfusion module based on a peristaltic (roller) pump with an integrated control unit, for example, the Mars module developed by the Central Research Institute of Robotics and Technical Cybernetics, St. Petersburg;

3 - oxygenator, for example, manufactured by Gish Vision Biomedical, Inc, USA;

4 - leukocyte filter, for example, manufactured by Pall GmbH, Germany;

5 - capacity for preserving solution;

6 - portable oxygen source with a system of reduction gears;

7 - absorption filter based on a composite material with nanocarbon;

8 - two-balloon three-lumen catheter, for example, brand 16 F, manufactured by "Balton, Ltd", Poland;

9 - venous cannula.

The inlets of the venous reservoir 1 are connected via connecting tubes to a container 5 for preserving solution, from which all the components of the perfusion solution, except blood, are introduced into the circulation circuit and to a venous cannula 9 installed in the inferior vena cava of the donor. The output of the venous reservoir 1 is connected to the input of the perfusion module 2, the output of which is connected to the arterial line of the perfusion circuit with the oxygenator 3, leukocyte filter 4 and absorption filter 7 connected in series. The output of the arterial line is connected to a two-balloon three-lumen catheter 8 inserted into the donor’s aorta.

Figure 2 marked

10 - organ storage chamber, made in the form of a disposable container made of transparent plastic;

11 - perfusion module with a peristaltic pump and an integrated control unit;

12 - sensor block;

13 - oxygenator with a built-in oxygen source;

14 - leukocyte filter;

15 - absorption filter.

The device for perfusion of an isolated organ contains an organ storage chamber 10 equipped with an arterial port (cannula) providing a connection of the arterial line of the circulation circuit with the artery of the donor organ, as well as a block of 12 sensors (pressure, temperature, gas bubbles, etc.), the readings of which are processed by the block control perfusion module 11. Venous outflow from the body is carried out directly into the chamber 10 and does not require a special connector. Inlet and outlet from the chamber 11 of the perfusate, as well as sampling of the perfusate for analysis is carried out through special nozzles of the chamber (not shown for simplicity). The outlet pipe for the perfusate from the organ storage chamber 10 is connected via the venous line of the circulation circuit to the input of the perfusion module 11. An arterial line of the circulation circuit with an oxygenator 13, a white blood cell filter 14 and an absorption filter 15 is connected to the output of the perfusion module.

The method is as follows.

After the arrival of the transplant team and obtaining permission to remove the organ, the donor is delivered to the operating room. Access the femoral vessels of the right limb, then perform an arteriotomy of the common femoral artery, through which a two-balloon three-lumen catheter 8 is inserted into the donor’s aorta, the upper balloon of which occludes the aorta above the renal arteries. A cardiac surgical venous cannula 9 (or a catheter into the inferior vena cava) is installed through the femoral vein, through which perfusion solution circulating in the circuit is discharged into the venous reservoir 1 with a capacity of 4-4.5 L and the vascular bed is decompressed.

After this, perfusion of the organs of the abdominal region (abdominal cavity) in the body of the donor begins. The initial filling of the perfusion circuit is performed with the Custodiol preservative solution in a volume of 1.5-2 l at an initial flow rate of 500 ml / min and a rotational speed of the rotor of the peristaltic pump of 30 rpm, which are set by adjusting the controls on the front panel mechatronic perfusion module 2.

As the vascular bed is freed from the blood flowing into the venous reservoir 1, the perfusion rate is gradually increased (to the middle of the perfusion cycle) to 1200 ml / min and heparin (50,000 units), streptokinase (1.5 million units) are gradually introduced into the reservoir 400-600 ml of perftoran, 300 μg of solomedrol, 5 mg of isoptin and 5 mg of nitroglycerin.

The choice of composition of the perfusate is determined by the following.

The introduction of the Custodiol preservative solution into the composition of the perfusate makes it possible to stabilize cell membranes and reduce edema of endothelium and tissues of ischemic damaged donor organs.

The presence of perfluoran in it allows to improve the delivery of oxygen to tissues, to improve metabolism and gas exchange at the tissue level, which maintains a minimum level of metabolism of perfused tissues. In addition, perftoran is able to attenuate endothelial damage, which is associated with its membrane protective properties, with the ability to inhibit the adhesion, chemotaxis and metabolism of leukocytes, and also weaken the interaction between leukocytes and endothelium, thereby reducing the degree of leukocyte-induced tissue damage of the donor organ.

The presence of streptokinase and heparin in the solution allows pharmacological action on conglomerates of activated white blood cells with blood cells, disconnecting their connections, which helps to remove white blood cells and restore the patency of the vascular bed, thereby reducing the degree of reperfusion injury and improving the quality of the graft.

The introduction of solomedrol into the perfusate has an anti-inflammatory, anti-allergic, anti-shock and immunosuppressive effect on the donor organ.

The use of isoptin prevents the entry of calcium into the cells, which stimulates the process of cell destruction, and the use of nitroglycerin ensures the stabilization of endotheliocyte membranes.

Perfusion of the abdominal region of blood supply in the body of the donor is carried out for 2-3 hours at a temperature of 23-27 ° C (normothermal conditions) and an oxygen flow rate of 200-250 ml / min.

At the same time, the use of a leukocyte filter 4 in the circuit allows the vascular bed to be sanitized by activated leukocytes, leukocyte conglomerates between themselves and blood cells, and thereby reduce the degree of microcirculatory disturbance, leukocyte-induced tissue damage and ischemic reperfusion injury, and increase the viability of donor body.

Using an absorption filter allows you to remove from the perfusate under-oxidized products of biochemical decay and normalize the pH of the solution.

The choice of the temperature regime is due to the fact that the restoration of the energy and functional potential of the donor organ and the effect on the microvasculature are possible only in physiological, normothermic conditions.

Perfusion of the abdominal blood supply region in the donor’s body for 2-3 hours is a necessary and sufficient time period during which the functional and energy potential of the cells of ischemically damaged organs is restored as completely as possible due to the supply of nutrients and oxygen to the tissues and the preparation of the donor organ ends to the next stage - normothermic perfusion of an isolated organ.

In this case, the decision on the possibility of organ removal is also taken on the basis of the results of a study of the leukocyte content in the circulating perfusate stream. Upon reaching a white blood cell count of 1 × 10 ⁹ units. and below, perfusion results are considered satisfactory.

The operation of the explantation of donor organs (eg, kidneys) is performed with ongoing perfusion, which is stopped immediately before organ removal.

After the organ is removed from the donor’s body, the renal artery is treated, which is fixed in the perfusion cannula, the organ is placed in a special cassette and the organ is fixed in the organ storage chamber 10 of the perfusion apparatus, which is filled with 1 l perfusion solution. The perfusion cannula is connected to the arterial line of the device, and the venous line of the device is connected to the outlet pipe of the perfusate from the chamber, because the outflow from an organ vein is passive.

An example of the implementation of an apparatus for perfusion of an isolated organ is the Life Port ™ apparatus of Organ Recovery System, USA, made on the principle of a thermally insulated box with a transparent sealed organ storage chamber, an integrated roller pump, a solution flow meter, temperature sensors, and pressure sensors , a perfusion parameter control unit and a computer converter that allows graphical display of information.

In the process of normothermic perfusion of an isolated organ, as in the first stage (perfusion of the abdominal blood supply region in the body of the donor), the perfusate solution is oxygenated and purified by leukocyte and absorption filters. As a perfusate, a modified solution based on blood of the same composition as in the first stage, at a temperature of 23-27 ° C, is used.

At the stage of perfusion of an isolated organ, donor organs are selected and, if the organ is recognized as suitable for transplantation, perfusion continues to maintain the functional state of the organ until the moment of transplantation.

Selection of organs is carried out during the period of "test monitoring", which lasts 4-6 hours.

At this time, the degree of disclosure of the circulatory bed of blood vessels of the organ circulatory system, which is determined by the change in the resistive index (RI), is manifested. This indicator, according to most researchers [Morgan S. et al. Outcomes after transplantation of deceased-donor kidneys with rising serum creatinine / S. Morgan [et al.] // American Journal of Transplantation. - 2007. - Vol.7 - P.1288-1292], is crucial for assessing the quality of the graft and is defined as the ratio of the systolic pressure installed in the apparatus to the value of the perfusion stream passing through the graft per unit time:

,

,

where RI is the resistive index,

P _syst - systolic pressure, mm Hg,

V is the perfusate flow rate, ml / min.

The initial systolic pressure in the perfusion circuit is set depending on the condition of the graft. With its optimal condition, it is 35 mm Hg, and for grafts with dubious (borderline) characteristics - 40-45 mm Hg.

If RI does not decrease within 4-6 hours of perfusion or, on the contrary, its increase occurs, and the perfusate flow rate through the organ is significantly lower than the normal value (100-150 ml / min), this is the basis for refusing organ transplantation.

If a decrease in RI occurs, but at a slow pace, systolic pressure is gradually increased, but not more than 5 mm Hg. simultaneously, and continue to observe. If in response to an increase in pressure there is an increase in the flow rate through the organ by 10-15 ml / min, perfusion is continued at the selected parameters.

An organ is considered suitable for transplantation if within 4-6 hours the RI decreases by 2–3 times and the flow rate is set within 80–150 ml / min, after which perfusion is continued until the donor organ is transplanted.

If it is necessary to transport a donor organ to another medical institution, the organ storage chamber is placed in a refrigerated transport container, and during organ transportation, perfusion is continued with a preservation solution at a temperature of 4-7 ° C.

The effectiveness of the proposed method for restoring the viability of a donor organ is confirmed by the following examples of clinical cases.

Example 1

Donor W., man, 46 years old. March 18, 2010 at 19 hours 40 minutes delivered to the shock hall of the Research Institute of Emergency Medicine after a car accident with a diagnosis of closed craniocerebral injury, brain contusion, fracture of the cervical vertebrae, fracture of the left thigh, pelvis, hemopneumothorax on the left.

Laparocentesis was performed; data on damage to abdominal organs were not revealed. Hypotension. Dopamine at a dose of 15-20 mg / kg / min for 4 hours. Unstable hemodynamics at the level of 80-95 mm Hg Oliguria less than 30 ml per hour. Drainage of the left pleural cavity was performed, skeletal traction was imposed on the left thigh. Indications for craniotomy are not revealed.

Sudden cardiac arrest at 23 hours 55 min. Resuscitation measures for 30 minutes in full are unsuccessful. Death statement - 00 hours 30 min, March 19. During the implementation of resuscitation measures, the transplant coordinator called for a team to remove organ donation from the Center. Regional coordinator notified forensic expert.

At the same time, at 00 hours 35 min, blood was taken from a donor corpse for typing and serological tests. At 00 hours 45 minutes the donor corpse was delivered to the operating room. At 0115 hours access to the femoral vessels was made, the femoral artery and vein were cannulated. At 01 h 36 min, normothermic extracorporeal instrumental perfusion with oxygenation and leukocyte removal was started. Perfusion parameters: speed from 500 to 1200 ml / min, oxygen flow rate of 200-250 ml / min, solution temperature 25-27 ° C. 2 liters of Custodiol preservative solution, perfluoran in a volume of 400 ml, streptokinase - 1.5 million units, solomedrol 300 μg, calcium channel blocker (isoptin - 5 mg), nitroglycerin - 5 mg were introduced into the circuit.

Arrival of the expert 1.5 hours after the death of the donor. Obtained permission to seize.

The beginning of a laparotomy at 03 hours 05 minutes. During a laparotomy, a massive retroperitoneal hematoma was found on the left, the left kidney is completely surrounded by a hematoma spreading to its gate. It was decided to refuse her seizure for transplantation (later taken for research). The right kidney is removed - without anatomical features. Uniformly pink in color with cyanosis patches. A puncture biopsy of the graft was performed, the material was sent to work according to emergency indications. The end of the perfusion at 03 hours 42 minutes.

After stopping the normothermic extracorporeal hardware perfusion, a right-sided nephrectomy was performed. Transplant without features, single vessels (one artery and vein). The transplant is processed, the cannula is connected to the artery. The kidney is placed in the organ storage chamber of the Life Port ™ apparatus to perfuse an isolated organ. The beginning of isolated extracorporeal perfusion at 04 hours 04 min. The systolic pressure of 45 mm is set. Hg, which is 10 mm higher than the standard, set by "default" by the manufacturer. During the first four hours, the resistive index decreased from 0.78 to 0.64, while the flow rate through the renal transplant increased from 45 to 57 ml / min. According to the results of test monitoring, which revealed a slight decrease in the resistive index and an increase in flow rate, it was decided to continue perfusion. After 10 hours of observation, the resistive index decreased slightly and amounted to 0.59, and the perfusion rate decreased to 55 ml / min.

The results of a “zero” biopsy were obtained - pronounced ischemic damage to the epithelium of the renal tubules, signs of arterial hyalinosis, glomerulosclerosis and fibrosis were not detected. After finding out the reasons for the low efficiency of the results of hardware perfusion, the kidney was found unsuitable for transplantation.

Example 2

Donor M., 35 years old, male. October 16, 2009, at 04.25 a.m., he was admitted to the shock hall of a multi-disciplinary hospital in St. Petersburg with a diagnosis of closed craniocerebral trauma, severe brain contusion. Clinically, the patient from the moment of admission - atonic coma. From 6 hours 15 minutes to 8 hours 15 minutes, the patient underwent decompressive craniotomy in connection with an increasing intracerebral hematoma. At 0825 hours a sudden cardiac arrest occurred. Resuscitation measures within 35 minutes - unsuccessfully. At 09:00 a biological death of the patient was ascertained.

Report to the transplant centers at 09 hours 05 min. Arrival of the donor service at 09 54 min. At the same time, at 09.20 a.m. blood was taken from a donor corpse for typing and performing serological tests; a forensic expert was called. At 10 hours 05 minutes the donor corpse was delivered to the operating room. At 10 hours 15 minutes access to the femoral vessels was performed, cannulation of the femoral artery and vein was performed. At 10:31 a normothermic extracorporeal apparatus perfusion of the abdominal region in the donor’s body was started with oxygenation and leukocyte removal from the perfusaut. Perfusion parameters: speed from 500 to 1200 ml / min, oxygen flow rate of 200-250 ml / min, solution temperature 25-27 ° C. Consistently, 1.5 L of Custodiol preservative solution, perfluoran in a volume of 600 ml, streptokinase - 1.5 million units, solomedrol - 300 μg, heparin - 50,000 units, isoptin - 5 mg, nitroglycerin - 5 mg were introduced into the perfusion circuit.

At 11 hours 28 minutes permission of the forensic expert for the removal of donor organs was obtained. The beginning of laparotomy at 12 hours 45 minutes. The organs in the abdominal cavity are pink in color, in some places there is a sluggish intestinal motility. As a result of the audit of the abdominal cavity, pathological changes in organs and the presence of pathological fluids were not detected. The isolation of both kidneys was performed according to the standard method. The ureters are cut off. With external irritation, slight peristalsis of the ureter is noted. From the lumen of the ureter, urine is separated dropwise. The end of the perfusion at 13 hours 11 min.

After perfusion was stopped, bilateral nephrectomy was performed. Transplants without features, single vessels (one artery and vein). Both transplants were processed, cannulae connected to arteries. The kidneys are placed in the organ storage chambers and connected to the Life Port ™ device arteries for perfusion of an isolated organ. The beginning of perfusion of an isolated organ is 13 hours 54 minutes.

Initial perfusion characteristics: perfusion solution - a modified solution based on blood, temperature 23-27 ° C, pressure in the circuit 30 mm Hg with a gradual increase over 3 hours to 40 mm Hg, initial perfusion rate of 55 ml / min, resistive index 0.58-0.65. The reduction of the resistive index over 10 hours to 0.23, the perfusion rate increased to 98 ml / min.

The kidneys are recognized as suitable for transplantation.

The first recipient is a 58-year-old woman. After transplantation of a donor kidney, delayed function was observed for 32 days (14 hemodialysis procedures) with the restoration of acceptable creatinine values (213 mmol / L) by 36 days after transplantation. By the third month after transplantation, creatinine was 134 mmol / L.

The second recipient is a woman of 61 years old. After transplantation of a donor kidney, delayed function was observed for 21 days (9 hemodialysis procedures) with the restoration of acceptable creatinine values (178 mmol / L) by day 27 after transplantation. By the third month after transplantation, creatinine was 128 mmol / L.

Thus, due to the phased perfusion, the proposed method allows you to restore the viability of donor organs with border characteristics, more accurately assess their suitability for transplantation and for a long time to maintain the functional state of the organ suitable for transplantation.

Claims (3)

1. A method of restoring and maintaining the viability of an ischemic damaged donor organ, including explanting an organ from a donor’s body and performing a normothermic perfusion of an isolated organ with a pulsating flow of blood-based oxygen-enriched perfusate, characterized in that normothermic abdominal perfusion is carried out for 2-3 hours before organ explantation blood supply region in the donor’s body with a pulsating flow of oxygen-enriched blood-based perfusate, from which t activated leukocytes and under-oxidized products of biochemical decay, then the organ is explanted and, during normothermic perfusion of an isolated organ, its suitability for transplantation is assessed, and in case of an optimal implant condition, the initial systolic pressure is set to 35 mm Hg, and for implants with border ischemic lesions initial systolic pressure is set in the range of 40-45 mm RT.article, then determine the degree of disclosure of the circulatory bed or Ghana to change the value of the resistive index, and if within 4-6 hours the value of the resistive index does not decrease or increases, the organ is considered unsuitable for transplantation, and if during this time the value of the resistive index decreases by 2-3 times and the flow rate is set to within 80-150 ml / min, perfusion is continued until the organ transplant. 2. The method according to claim 1, characterized in that the perfusate in a volume of 4-4.5 l contains:
preserving solution 1,5-2 l perfluoran 400-600 ml heparin 50,000 units streptokinase 1.5 million units solomedrol 300 mcg isoptin 5 mg nitroglycerine 5 mg autoblood rest 3. The method according to claim 1, characterized in that, if it is necessary to transport an organ, the organ storage chamber is placed in a refrigerated transport container, and during transportation, perfusion is performed with a preservation solution at a temperature of 4-7 ° C.

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