Organ transplantation. One of the biochemical reasons for the race against the clock

: The authors have studied the subcellular functioning of human adrenal glands removed from subjects in a stage IV coma. The present study has a two-fold interest: on the one hand, it offers biochemical information on a key element in the intermediate metabolism (namely, the mitochondrial energetic metabolism, occurring in a fragile tissue which, under a state of shock, is primarily affected; the results obtained on such type of tissue may therefore be inferred to other organs); on the other hand, it allows a wider approach of the adrenal biochemical mechanisms during a stage IV coma. The mitochondrial fraction was obtained by differential centrifugation carried out immediately after organ removal. The steroid synthesis, studied using radioactive precursors, turned out to be similar to that found in other mammals. Respiratory characteristics, determined by polarography with a Clark oxygen electrode, at 37 degrees C, were satisfactory: respiratory intensity was 77.25 +/- 12.16 nanomoles O2/min/mg mitochondrial protein in the presence of succinate 15 mM and respiratory control was 1.93 +/- 0.15 in the presence of ADP 37 microM. The respiratory chain functioned in a classical manner: rotenone 25 microM did not inhibit respiration in the presence of succinate 15 mM, while it did with L-malate 15 mM. In the presence of succinate 15 mM, the respiratory intensity was inhibited at 87.4 percent and 76.7 percent by KCN 0.01 microM and antimycin A 0.09 microM respectively; with DNP 85 microM, it was multiplied by 5. However, the value of the P/O ratio was low (0.24 +/- 0.04). Under the present conditions, this may highlight the difficulty to synthetize ATP whenever neither the functioning nor the regulation of the multi-enzymatic complex accounting for oxygen consumption are affected. This result clearly confirms that the shortest possible delay between organ removal and transplantation is crucial, as the renewal of cell structures requires energy. These fundamental research studies account for the major concerns of reanimation teams. This also raises the issue of the role of fundamental researchers within a transplant surgery team.