2013-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/644627摘要：為解決器官來源的不足，『無心跳器官捐贈（ Non-Heart-Beating Donation，簡稱 NHBD）』可以提供另一種醫學上可行且能合法增加器官來源的方式，現今也已被許多先進國家（ 包括荷蘭、西班牙、英國、美國、日本等國 ）廣泛地使用於例行的器官移植手術。所謂的無心跳器官捐贈，是指一般疾病末期患者且已簽署器官捐贈同意書者，當其難以用腦死判定方式來捐贈器官時，可以在確認患者的心跳停止跳動後（即所謂的心臟死），以無心跳作為死亡判定，再執行器官捐贈程序。然而在 無心跳器官捐贈 的過程中，抗凝血劑的使用時機一直是個廣受爭議的議題。我們知道在捐贈者的心臟尚未停止跳動前給予抗凝血劑，可以有效地避免心臟停止跳動後因為血液凝固而造成的器官受損，也能夠防止血栓形成對捐贈器官造成的傷害。但是在心跳尚未停止前施打抗凝血劑的這個動作，卻是存在著許多醫學倫理上的爭議，因為它實際上並無助於捐贈者的醫療，只是為了保護捐贈器官。為了能深入瞭解抗凝血劑的使用對無心跳器官捐贈的影響，我們擬申請一以豬隻為標的的動物實驗，模擬實際執行無心跳器官捐贈時的情境，針對不同時間點給予抗凝血劑，並配合使用體外肺灌流（Ex Vivo Lung Perfusion, 簡稱 EVLP）的實驗模式，來評估各種不同情境下捐贈的肺臟，其器官功能是否有差異。<br> Abstract: After the first clinical success in the late 20th century, lung transplantation (LTx) has been recognized as the mainstay therapy for patients with end-stage pulmonary disease refractory to medical treatment. Donors who are declared dead by neurological criteria proved most of the organs nowadays. However, only 15%~20% of the brain-dead donors have lungs that are deemed transplantable. Because of a shortage of brain-dead donor, like all solid organ transplantation, LTx is struggling with the demand of donor organs exceeding supply. This resulted to the current phenomenon that the significant number of patients accepted for LTx who die while on the waiting list, especially in Asian countries. Therefore, attempts to improve the supply of donor lungs by aggressive donor management are actively being practiced to minimize the widely documented mismatch of demand and supply. There are several approaches recently developed to address this issue and potentially increase the donor pool for LTx. One of the most important approaches is the use of organs procured from non-heart-beating donation (NHBD). Recently, successful LTx has been reported by several groups worldwide and the number of programs using donors from NHBD for LTx has increased substantially. Actually, the number of lung donors from NHBD has increased 24% from 2006 to 2008. Moreover, several studies have demonstrated comparable if not better outcomes using donors from NHBD compared with donors from brain death. As we known, the main issue to perform a successful organ transplantation using the donors donated from cardiac death is to prevent the intravascular thrombus formation in the transplanted organs. Adequate heparin infusion is the most effective method to prevent this fatal complication occurred during the process of prolong cardiac arrest period. However, it is still under widely discussion because there are some ethic issues concerned about the timing of intravenous heparin infusion during the process of cardiac arrest. Therefore, the primary object of this program was to set up the animal model of NHBD to evaluate the effect of systemic heparinization during the donor’s procurement from NHBD. Moreover, we will set up and use the newly developed technique of normothermic ex vivo lung perfusion (EVLP) to further evaluate these suboptimal lungs from a non-heart-beating donors.