Donation After Circulatory Death: A New Frontier

Joshi, Yashutosh; Villanueva, Jeanette; Gao, Ling; Hwang, Bridget; Zhao, Christine; Doyle, Aoife; Wu, Jianxin; Jansz, P.; Macdonald, Peter S.

doi:10.1007/s11886-022-01798-y

Cited by 17 publications

(5 citation statements)

References 49 publications

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“…32 Subsequently, OCS gained popularity, enabling resuscitation, preservation and partly viability assessment of the donor heart before implantation. 32,33…”

Section: Dcd-heart Transplant: Procurement Methods and Perfusion Stra...mentioning

confidence: 99%

Donation After Circulatory Death Heart Transplant: Current State and Future Directions

Kharawala,

Nagraj,

Seo

et al. 2024

Circ: Heart Failure

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Orthotopic heart transplant is the gold standard therapeutic intervention for patients with end-stage heart failure. Conventionally, heart transplant has relied on donation after brain death for organ recovery. Donation after circulatory death (DCD) is the donation of the heart after confirming that circulatory function has irreversibly ceased. DCD-orthotopic heart transplant differs from donation after brain death-orthotopic heart transplant in ways that carry implications for widespread adoption, including differences in organ recovery, storage and ethical considerations surrounding normothermic regional perfusion with DCD. Despite these differences, DCD has shown promising early outcomes, augmenting the donor pool and allowing more individuals to benefit from orthotopic heart transplant. This review aims to present the current state and future trajectory of DCD-heart transplant, examine key differences between DCD and donation after brain death, including clinical experiences and innovations in methodologies, and address the ongoing ethical challenges surrounding the new frontier in heart transplant with DCD donors.

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“…32 Subsequently, OCS gained popularity, enabling resuscitation, preservation and partly viability assessment of the donor heart before implantation. 32,33…”

Section: Dcd-heart Transplant: Procurement Methods and Perfusion Stra...mentioning

confidence: 99%

Donation After Circulatory Death Heart Transplant: Current State and Future Directions

Kharawala,

Nagraj,

Seo

et al. 2024

Circ: Heart Failure

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“…Modification of practice is needed to allow for the acceptance of more marginal donors which remain underutilized 97 . Evolving initiatives to use organs from donation after cardiac death (DCD) need to be further expanded in the pediatric age group as has been the case in adult heart transplantation, 98 including the development of pediatric ex vivo perfusion devices 99,100 …”

Section: Unmet Challenges and Future Directionsmentioning

confidence: 99%

Pediatric heart transplantation: Looking forward after five decades of learning

Dipchand,

Webber

2023

Pediatric Transplantation

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Heart transplantation has become the standard of care for pediatric patients with end‐stage heart disease throughout the world. Since the first transplant was performed in 1967, the number of transplants has grown dramatically with 13 449 pediatric heart transplants being reported to The International Society of Heart and Lung Transplant (ISHLT) between January 1992 and June 30, 2018. Outcomes have consistently improved over the last few decades, specifically short‐term outcomes. Most recent survival data demonstrate that recipients who survive to 1‐year post‐transplant have excellent long‐term survival with more than 60% of those who were transplanted as infants being alive 25 years later. Nonetheless, the rates of graft loss beyond the first year have remained relatively constant over time; driven primarily by our poor understanding and lack of treatments for chronic allograft vasculopathy (CAV). Acute rejection, CAV, graft failure, and infection continue to be the major causes of death within the first 5 years post‐transplant. In addition, renal dysfunction, malignancy, and the need for re‐transplantation remain as significant issues that require close follow‐up. Looking forward, key challenges include improving donor utilization rates (including donation after cardiac death (DCD) and the use of ex vivo perfusion devices), the development of non‐invasive biomarkers for rejection, efforts to mitigate the long‐term effects of immunosuppression, and prevention of CAV. It is not possible to cover the entire evolution of pediatric heart transplantation over the last five decades, but in this review, we hope to touch on key observations, lessons learned, and practice changes that have advanced the field, as well as glance ahead to the next decade.

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“…1,2 Furthermore, the use of DCD hearts has increased transplantation activity by 26%-48%. 3,4 Now that the feasibility and benefits of DCD heart transplantation have been demonstrated, 5 research is required to optimize clinical protocols. For example, cardioprotective strategies upon reperfusion could be applied to limit graft injury and improve graft quality.…”

Section: Introductionmentioning

confidence: 99%

“…According to first results, DCD hearts provide similar 5‐year outcomes in terms of graft survival, rejection episodes and hospital stay when compared to cohorts of heart transplant patients receiving grafts obtained with conventional donation after brain death 1,2 . Furthermore, the use of DCD hearts has increased transplantation activity by 26%–48% 3,4 …”

Section: Introductionmentioning

confidence: 99%

Macrophage‐derived extracellular vesicles alter cardiac recovery and metabolism in a rat heart model of donation after circulatory death

Graf,

Biemmi,

Arnold

et al. 2024

J Cellular Molecular Medi

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Conditions to which the cardiac graft is exposed during transplantation with donation after circulatory death (DCD) can trigger the recruitment of macrophages that are either unpolarized (M0) or pro‐inflammatory (M1) as well as the release of extracellular vesicles (EV). We aimed to characterize the effects of M0 and M1 macrophage‐derived EV administration on post‐ischaemic functional recovery and glucose metabolism using an isolated rat heart model of DCD. Isolated rat hearts were subjected to 20 min aerobic perfusion, followed by 27 min global, warm ischaemia or continued aerobic perfusion and 60 min reperfusion with or without intravascular administration of EV. Four experimental groups were compared: (1) no ischaemia, no EV; (2) ischaemia, no EV; (3) ischaemia with M0‐macrophage‐dervied EV; (4) ischaemia with M1‐macrophage‐derived EV. Post‐ischaemic ventricular and metabolic recovery were evaluated. During reperfusion, ventricular function was decreased in untreated ischaemic and M1‐EV hearts, but not in M0‐EV hearts, compared to non‐ischaemic hearts (p < 0.05). In parallel with the reduced functional recovery in M1‐EV versus M0‐EV ischaemic hearts, rates of glycolysis from exogenous glucose and oxidative metabolism tended to be lower, while rates of glycogenolysis and lactate release tended to be higher. EV from M0‐ and M1‐macrophages differentially affect post‐ischaemic cardiac recovery, potentially by altering glucose metabolism in a rat model of DCD. Targeted EV therapy may be a useful approach for modulating cardiac energy metabolism and optimizing graft quality in the setting of DCD.

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Donation After Circulatory Death: A New Frontier

Cited by 17 publications

References 49 publications

Donation After Circulatory Death Heart Transplant: Current State and Future Directions

Donation After Circulatory Death Heart Transplant: Current State and Future Directions

Pediatric heart transplantation: Looking forward after five decades of learning

Macrophage‐derived extracellular vesicles alter cardiac recovery and metabolism in a rat heart model of donation after circulatory death

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