Waste Not, Want Not: Decreasing Wastage through the Utilization of Thermal Controlled Technology with Ex Vivo Lung Perfusion

Purpose The Organ Care System (OCS) (TransMedics, Andover, MA) is one type of revolutionary ex vivo organ perfusion technology that expands the organ retrieval range while limiting ischemic time significantly. OCS Lung is the only FDA-approved, portable, normothermic lung perfusion system for standard and expanded criteria donor lungs. Current ex vivo lung perfusion (EVLP) systems use a variety of perfusates. OCS Lung uses packed red blood cells (pRBC) diluted in the OCS Lung solution. We report the ability to reduce blood waste for up to 12 hours using a thermal packaging solution in conjunction with an EVLP system. Methods We performed a retrospective analysis of all OCS Lung recoveries at our hospital that used banked blood from May 2019 to May 2020. Three units of leukocyte-reduced, ABO compatible, cross-matched pRBC are transported for EVLP perfusate. These pRBC units are CMV seronegative when indicated (both recipient and donor CMV seronegative). During the first six months, units were stored using the Coleman Performance Wheeled Cooler (Coleman Company, Chicago, IL) that has been validated to maintain a temperature range of 1° to 6°C for 4 hours. During the following six months, units were stored using a Crēdo ProMed Cooler (Pelican BioThermal, Plymouth, MN) that has been validated to maintain a temperature range of 1° to 6°C for 12 to 72 hours. Results We provide documentation of unit disposition and duration in the respective cooler as well as the impact expanded organ retrieval range has on unit viability. (Table 1-3). Conclusion The use of an advanced thermal packaging solution facilitates the proper storage temperature of pRBC for the extended period of time required for organ retrieval. This finding represents a significant advancement in the storage of blood perfusate used for donor lung preservation. The ability to eliminate blood wastage could result in an average annual saving of $3,000 and warrants further multicenter investigation.