Heart transplant donation after circulatory death: current status and implications

Abstract

Purpose of review The use of cardiac transplantation following circulatory death (DCD) has been limited worldwide. Concerns about cardiac function after warm ischemia and the potential for decreased graft function have been important considerations in this hesitancy. In addition, ethical and legal questions about the two widely used organ procurement methods have led to discussions and public education in many countries. Recent findings Publication of a US randomized trial of cardiac transplantation following DCD has shown that it is both feasible and has similar short-term outcomes compared with cardiac transplantation following brain death (DBD). These data support those from both Australia and the UK who have largest experience to date. Summary The adoption of cardiac transplantation following circulatory death has increased overall cardiac transplantation in those transplant centers who have incorporated these donors. Short term outcomes for DCD organ procurement methods are similar to those outcomes using DBD hearts. Continued study and standardization of warm ischemic times will allow for better comparisons of organ procurement techniques and organ optimization. The ethical concerns about procurement methods, in addition to a discussion of procurement costs and feasibility will need to be addressed further in the efforts to expand the organ pool and increase overall cardiac transplantation numbers.

Heart Transplantation

“…Advances in the pre-transplantation field, such as the inclusion of hepatitis C donors or donation after circulatory death and ex situ donation, focus on the expansion of the organ donor pool [104][105][106][107]. Furthermore, advances after HTx include novel monitoring for acute cellular rejection (Figure 1) [108] and antibody-mediated rejection (i.e., cell-free DNA, gene expression profiling, and micro RNA molecular microscopy) [109].…”