Impact of Donation After Circulatory Death Heart Transplantation on Waitlist Outcomes and Transplantation Activity

Urban, Marian; Moody, Morgan; Castleberry, Anthony W.; Lowes, Brian D.; Siddique, Aleem; Um, J.

doi:10.1016/j.healun.2022.01.106

Cited by 2 publications

(3 citation statements)

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“…Even if heart procurement in cDCD has been reported for longer fWIT (>30 min) with early clinical outcomes similar to DBD or cDCD with short fWIT, 3,4 this is the first case in the world reporting such an extremely long controlled cardiac asystolia before using the heart for transplantation. Within the fWIT, the asystolic period is the time included between the circulatory death declaration (no-touch period onset) and the cardiac reperfusion initiation.…”

Section: Discussionmentioning

confidence: 92%

“…Cardiac magnetic resonance (CMR) on POD #20 documented ventricles with normal volumes, preserved regional and global systolic function, strain indexes, and wall thickness, no myopericardial late gadolinium enhancement (Figure 2). Endomyocardial biopsies performed on POD #18, POD #26, and POD #32 found grade 1R, grade 0, and grade 0 cellular rejection, respectively (according to current International Society of Heart and Lung Transplantation guidelines 3 ). Focal signs of myocardial ischemic damage were found (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

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Overcoming the Boundaries of Heart Warm Ischemia in Donation After Circulatory Death: The Padua Case

Gerosa,

Zanatta,

Angelini

et al. 2024

ASAIO Journal

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A 45 year old male obese patient with a previous history of repaired congenital heart disease developed worsening heart failure making heart transplantation listing mandatory. Unfortunately, due to his anthropometric measures, the search for a suitable brain-dead donor was unsuccessful. For this reason, he accepted to be enrolled in the controlled donation after circulatory death (cDCD) program. According to the Italian Law regulating death declaration after cardiac arrest (no-touch period of 20 minutes—one of the longest in the world), we faced a 34 minute cardiac asystole, after which the heart was recovered through a thoraco-abdominal normothermic regional perfusion excluding the epiaortic vessels. The heart was then preserved by means of cold static storage. Heart transplantation was performed successfully without any signs of primary graft failure. Postoperative endomyocardial biopsies were negative for acute cellular and antibody-mediated rejection. Furthermore, echocardiographic and cardiac magnetic resonance evaluation of the heart did not show any functional abnormalities. The patient was discharged on post-operative day (POD) #39 in good clinical conditions.

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Section: Discussionmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Overcoming the Boundaries of Heart Warm Ischemia in Donation After Circulatory Death: The Padua Case

Gerosa,

Zanatta,

Angelini

et al. 2024

ASAIO Journal

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“…Reducing indirect costs associated with these downstream events, such as the daily cost of CCRT (>$15K) may be another area of savings [41]. The cost reduction observed with taNRP has naturally translated into a greater documented contribution margin [42], and fueled explosive growth in implementation over the last few years. Based on UNOS data from 2019 to 2023, the use of NRP for DCD recoveries has increased over 250%, rising from 12.5% in 2019 to 44% in 2023 [43].…”

Section: Cost Analysismentioning

confidence: 99%

Thoraco-abdominal normothermic regional perfusion for thoracic transplantation in the United States: current state and future directions

Bommareddi,

Lima,

Shah

et al. 2024

Current Opinion in Organ Transplantation

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Purpose of review To provide an update regarding the state of thoracoabdominal normothermic regional perfusion (taNRP) when used for thoracic organ recovery Recent findings taNRP is growing in its utilization for thoracic organ recovery from donation after circulatory death donors, partly because of its cost effectiveness. taNRP has been shown to yield cardiac allograft recipient outcomes similar to those of brain-dead donors. Regarding the use of taNRP to recover donor lungs, United Network for Organ Sharing (UNOS) analysis shows that taNRP recovered lungs are noninferior, and taNRP has been used to consistently recover excellent lungs at high volume centers. Despite its growth, ethical debate regarding taNRP continues, though clinical data now supports the notion that there is no meaningful brain perfusion after clamping the aortic arch vessels. Summary taNRP is an excellent method for recovering both heart and lungs from donation after circulatory death donors and yields satisfactory recipient outcomes in a cost-effective manner. taNRP is now endorsed by the American Society of Transplant Surgeons, though ethical debate continues.

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Impact of Donation After Circulatory Death Heart Transplantation on Waitlist Outcomes and Transplantation Activity

Cited by 2 publications

References 0 publications

Overcoming the Boundaries of Heart Warm Ischemia in Donation After Circulatory Death: The Padua Case

Overcoming the Boundaries of Heart Warm Ischemia in Donation After Circulatory Death: The Padua Case

Thoraco-abdominal normothermic regional perfusion for thoracic transplantation in the United States: current state and future directions

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