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OxPL are generated within cardiomyocytes during IR and have detrimental effects on cardiomyocyte viability. Inactivation of OxPL in vivo results in a reduction of infarct size.

Hearts donated following circulatory death (DCD) may represent an additional source of organs for transplantation; however, the impact of donor extubation on the DCD heart has not been well characterized. We sought to describe the physiologic changes that occur following withdrawal of life-sustaining therapy (WLST) in a porcine model of DCD. Physiologic changes were monitored continuously for 20 min following WLST. Ventricular pressure, volume, and function were recorded using a conductance catheter placed into the right (N ¼ 8) and left (N ¼ 8) ventricles, and using magnetic resonance imaging (MRI, N ¼ 3). Hypoxic pulmonary vasoconstriction occurred following WLST, and was associated with distension of the right ventricle (RV) and reduced cardiac output. A 120-fold increase in epinephrine was subsequently observed that produced a transient hyperdynamic phase; however, progressive RV distension developed during this time. Circulatory arrest occurred 7.6AE0.3 min following WLST, at which time MRI demonstrated an 18AE7% increase in RV volume and a 12AE9% decrease in left ventricular volume compared to baseline. We conclude that hypoxic pulmonary vasoconstriction and a profound catecholamine surge occur following WLST that result in distension of the RV. These changes have important implications on the resuscitation, preservation, and evaluation of DCD hearts prior to transplantation.Abbreviations: C a O 2 , arterial oxygen content; CO, cardiac output; DCD, donation after circulatory death; LV, left ventricle; MRI, magnetic resonance imaging; P a CO 2 , arterial partial pressure of carbon dioxide; P a O 2 , arterial partial pressure of oxygen; RV, right ventricle; UHPLC, ultra-high-performance liquid chromatography; WLST, withdrawal of life-sustaining therapy