Availability and function of donor organs: Debating the dead donor rule (3DR)
The convergence environment wants to increase availability and function of donor organs for transplantation and to create societal awareness and debate on ethical issues using Donation after Circulatory Death (DCD).
Project leader: Kåre-Olav Stensløkken, Professor, Institute for Basic Medical Sciences, Faculty of Medicine, Department of Molecular Medicine, UiO
- Professor Marius Timmann Mjaaland, Faculty of Theology, UiO
- Dr Sjanne Lefevre, Department of Biosciences, Section for Physiology and Cell Biology,Faculty of Mathematics and Natural Sciences, UiO
- Professor Göran Nilsson, Department of Biosciences, Section for Physiology and Cell Biology, Faculty of Mathematics and Natural Sciences, UiO
- Dr. Søren Erik Pischke, Institute of Clinical Medicine, Department of Immunology, Faculty of Medicine, UiO and Department of Anaesthesiology, Clinic for Emergencies and Critical Care, Oslo University Hospital
In Norway as in Europe, there is a shortage of organs for donation and patients die on waiting lists. The shortage of organs has led to investigations on the use of donation from deceased after circulatory death (DCD). These organs have been without blood flow and may be damaged. Moreover, there are important ethical issues connected to DCD that require a new public debate on the issue. These organs are therefore not used for transplantation in Norway.
In this project, we will raise an informed public debate and investigate how organs from DCD donors may be preserved for better function in patients. Our main aim is to increase availability and function of donor organs in Norway.
In almost all living organisms, oxygen is used in an organelle called the mitochondria, when molecules from the food we eat are turned into the energy transferring molecule ATP. When blood flow and oxygen delivery stops, there will be no ATP, the cells will die, and the organ collapses. However, we have showed that a fresh water fish naturally occurring in Norway, the crucian carp, can survive and remain active for months without oxygen (anoxia). We believe that the mechanisms used by the fish are universal and are translatable to humans, but this hypothesis requires further research to be confirmed.
We have planned four projects: Firstly, we will study how the fish reduce metabolism and thereby may save energy. Secondly, we will use our knowledge on the fish metabolism and mitochondria to make a fluid that will protect mammalian organs before they are transplanted. Thirdly, we will test how this perfusion fluid may reduce inflammation and increase survival in organs not suitable for donation in patients. The fourth projects will bring all this knowledge to the public and create a platform for ethical and political debate on organ donation. It is critical that there is a public debate and general confidence in the population about these issues.
All the four subprojects will lead into a common deliverable during summer 2023, “New methods and suggestions on cardiac transplantation in DCD”.
- Increase availability and function of donor organs for transplantation
- Create social awareness and debate on ethical issues using donation after circulatory death
- Show how hypometabolism is induced in the anoxia tolerant fish
- Preserve mitochondrial function without oxygen in mammals
- Preserve organs against oxygen deprivation and protect them against reperfusion injury