Heart transplantation from donation after circulatory death donors: Present and future

Abstract

The first successful human heart transplantation was reported on 3 December 1967, by Christiaan Barnard in South Africa. Since then this life‐saving procedure has been performed in over 120 000 patients. A limitation to the performance of this procedure is the availability of donor hearts with as many as 20% of patients dying before a donor's heart is available for transplant. Today, hearts for transplantation are procured from individuals experiencing donation after brain death (DBD). Interestingly, this, however, was not always the case as the first heart transplants occurred after circulatory death. Revisiting the availability of hearts for transplant from those experiencing donation after circulatory death (DCD) could further expand the number of hearts suitable for transplantation. There are several considerations pertinent to transplanting hearts from those undergoing circulatory death. In this review, we summarize the main distinctions between DBD and DCD heart donation and discuss the research relevant to increasing the number of hearts available for transplantation by including individual's hearts that experience circulatory death.

Targeting the NLRP3 inflammasome to reduce warm ischemic injury in donation after circulatory death heart

“…At present, despite the controlled conditions in DBD heart donors, post‐transplantation primary graft dysfunction, which is a reflection of inadequate myocardial protection (cold storage injury and longer ischemia times), is reported between 4% and 22%, with very high mortality‐ 31.8% 24 . Since ischemia is inherent to the DCD process, except for a few centers, 5,6,21 DCD hearts are not routinely utilized for transplantation. However, if there are interventions to limit myocardial damage in DCD hearts, especially during reperfusion, these hearts could potentially be utilized for clinical transplantation.…”

“…The DCD process is less controlled; catecholamine surge after the termination of ventilation is several folds higher compared with DBD donors, 20 and warm ischemia duration is variable. The current clinical practice accepts less than 30 minutes of ischemia (time from a decrease in systolic blood pressure of less than 50 mmHg following the withdrawal of ventilator support to reperfusion of coronaries), before declining heart procurement from DCD donors 21 . Based on this timeline, we elected to keep the DCD ischemia time in our experimental model at 40 minutes, which allowed time to decrease systolic BP to <50 mmHg (five minutes) and targeted an ischemia time of at least 30‐35 minutes.…”

Anesthetic Considerations During Heart Transplantation Using Donation After Circulatory Death

“…Protocols from other institutions use very similar parameters to determine organ acceptance. [9][10][11][12] Hemodynamic parameters had to remain stable for acceptance. Transesophageal echocardiography parameters for acceptance are left ventricular systolic function 50%, normal right ventricular function, and normal biventricular chamber size.…”

Courage and Character, Leaders and Legends: An Interview With Nader Moazami, MD

“…Reports were indicating that the use of DCD hearts in special instances can lead to an increase in organs for heart candidates. 3 Dr Moazami performed the third DCD heart transplant in the United States but was the first performed with an in situ donor heart. The first 2 were performed using the Transmedic Organ Care System whereby the heart was perfused en route to a more distant site.…”