Ex Situ Perfusion of Hearts Donated After Euthanasia: A Promising Contribution to Heart Transplantation

Abstract

Background. Organ donation after euthanasia is performed in an increasing number of countries. In this donation after circulatory death procedure, it has not been possible to donate the heart. Recent literature, however, reports positive results of heart donation after circulatory death. Therefore, patients who donate organs following euthanasia might be suitable candidates for heart donation. We want to confirm this assumption by sharing the results of 2 cases of heart donation following euthanasia with ex situ subnormothermic heart preservation. Our aim is to raise awareness of the potential of heart donation following euthanasia for both clinical transplantation and research. Methods. The data of 2 consecutive heart donations following euthanasia were collected prospectively. Informed consent was obtained from the patients themselves for heart donation for research purposes. An acellular oxygenated subnormothermic machine perfusion strategy was used to preserve both donor hearts. Subsequently, the hearts were evaluated on a normothermic perfusion machine using a balloon in the left ventricle. Results. Heart donation following euthanasia was feasible without significant changes in existing retrieval protocols. Duration of machine perfusion preservation was 408 and 432 minutes, for heart 1 and 2, respectively. For heart 1, developed pressure (P dev ) was 119 mm Hg, maximal rate of pressure rise (dP/dt max ), and fall (dP/dt min ) were 1524 mm Hg/s and −1057 mm Hg/s, respectively. For heart 2, P dev was 142 mm Hg, dP/dt max was 1098 mm Hg/s, and dP/dt min was −802 mm Hg/s. Conclusions. Hearts donated following euthanasia are highly valuable for research purposes and can have sufficient quality to be transplanted. With the implementation of ex situ heart perfusion, patients who are to donate their organs following euthanasia should also be able to donate their hearts. The complex combination of euthanasia and heart donation is ethically sound and surgically feasible and can contribute to shortening the heart transplant waiting list.

Outcomes of lung transplantation from organ donation after medical assistance in dying: First North American experience

“…In fact, initial results of MAID donors reported from Belgium and the Netherland group demonstrated good outcomes for the recipients 21,22 . Recently, the potential of heart donation from MAID donors were raised by the quality assessment with ex situ heart perfusion 23 . In the field of lung transplantation, the group from Leuven reported good short‐term and long‐term outcomes 24,25 …”

“…21,22 Recently, the potential of heart donation from MAID donors were raised by the quality assessment with ex situ heart perfusion. 23 In the field of lung transplantation, the group from Leuven reported good short-term and long-term outcomes. 24,25 MAID and DCD are not legal or practiced in most jurisdictions, but when considering eligible MAID recipients for organ donation, a recent guidance document recommended three things 3 : (1) firstperson consent for organ donation after MAID should be an option in jurisdictions that allow MAID; (2) in order to avoid the potential for a MAID request to be driven by a desire to donate organs (rather than for intolerable suffering, etc.…”

Organ donation following medical assistance in dying, Part I: a scoping review of legal and ethical aspects

“…1,4,25,53,63,70,72 In The Netherlands, MAiD was enacted through the Dutch Euthanasia Act 2002 (Dutch Termination of Life on Request and Assisted Suicide Act). 3,4,25,66,67,70 More details regarding this legislation and the eligibility criteria can be found in Appendix IV.…”

Missed opportunities: saving lives through organ donation following voluntary assisted dying

“…Nevertheless, if the development of dVAD programmes in Australia resulted in only a 2% increase in the annual number of deceased donors, this could mean an additional eight donors per year based on 2020 figures, 1 with the potential to help several people depending on how many organs are successfully recovered for transplantation. Opportunities for dVAD may also increase as new protocols facilitate organ recovery in a range of settings and enable repair or regeneration of organs following donation 4,16,17 . Furthermore, although we focus here on the complexities of organ donation, tissue donation is likely to be possible for many people undergoing VAD and will provide significant benefits to those needing tissue transplants.…”

“…Opportunities for dVAD may also increase as new protocols facilitate organ recovery in a range of settings and enable repair or regeneration of organs following donation. 4,16,17 Furthermore, although we focus here on the complexities of organ donation, tissue donation is likely to be possible for many people undergoing VAD and will provide significant benefits to those needing tissue transplants.…”