Pediatric Heart Transplantation after Declaration of Cardiocirculatory Death

Boucek, Mark M.; Mashburn, C.; Dunn, Susan M. J.; Frizell, Rebecca; Edwards, Leah; Pietra, Biagio A.; Campbell, David N.

doi:10.1056/nejmoa0800660

Cited by 380 publications

(233 citation statements)

References 14 publications

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“…The limited human experience to date has been with DCD hearts subjected to relatively short WITs. Boucek et al (27) reported three successful pediatric heart transplants from DCD donors with WITs of 11.5-27 min (mean of 18.3 min). Ali et al (28) reported the reanimation of a human adult heart in vivo following a total WIT of 23 min; postresuscitation, the heart was able to support the donor's circulation.…”

Section: Discussionmentioning

confidence: 99%

Increasing the Tolerance of DCD Hearts to Warm Ischemia by Pharmacological Postconditioning

Iyer

Gao

Doyle

et al. 2014

American Journal of Transplantation

116

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Donation after circulatory death (DCD) offers a potential additional source of cardiac allografts. We used a porcine asphyxia model to evaluate viability of DCD hearts subjected to warm ischemic times (WIT) of 20-40 min prior to flushing with Celsior (C) solution. We then assessed potential benefits of supplementing C with erythropoietin, glyceryl trinitrate and zoniporide (Cs), a combination that we have shown previously to activate ischemic postconditioning pathways. Hearts flushed with C/Cs were assessed for functional, biochemical and metabolic recovery on an ex vivo working heart apparatus. Hearts exposed to 20-min WIT showed full recovery of functional and metabolic profiles compared with control hearts (no WIT). Hearts subjected to 30-or 40-min WIT prior to C solution showed partial and no recovery, respectively. Hearts exposed to 30-min WIT and Cs solution displayed complete recovery, while hearts exposed to 40-min WIT and Cs solution demonstrated partial recovery. We conclude that DCD hearts flushed with C solution demonstrate complete recovery up to 20-min WIT after which there is rapid loss of viability. Cs extends the limit of WIT tolerability to 30 min. DCD hearts with 30-min WIT may be suitable for transplantation and warrant assessment in a transplant model.

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Section: Discussionmentioning

confidence: 99%

Increasing the Tolerance of DCD Hearts to Warm Ischemia by Pharmacological Postconditioning

Iyer

Gao

Doyle

et al. 2014

American Journal of Transplantation

116

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“…In 2008, Boucek et al 27 reported successfully transplanting hearts from 3 infant donors in cases of DCD. Some criticized the waiting period of 75 seconds in 2 of the transplants as being too short.…”

Section: Declaration Of Deathmentioning

confidence: 99%

Ethical Controversies in Organ Donation After Circulatory Death

Antommaria¹,

Fallat²,

Katz³

et al. 2013

Pediatrics

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The persistent mismatch between the supply of and need for transplantable organs has led to efforts to increase the supply, including controlled donation after circulatory death (DCD). Controlled DCD involves organ recovery after the planned withdrawal of life-sustaining treatment and the declaration of death according to the cardiorespiratory criteria. Two central ethical issues in DCD are when organ recovery can begin and how to manage conflicts of interests. The “dead donor rule” should be maintained, and donors in cases of DCD should only be declared dead after the permanent cessation of circulatory function. Permanence is generally established by a 2- to 5-minute waiting period. Given ongoing controversy over whether the cessation must also be irreversible, physicians should not be required to participate in DCD. Because the preparation for organ recovery in DCD begins before the declaration of death, there are potential conflicts between the donor’s and recipient’s interests. These conflicts can be managed in a variety of ways, including informed consent and separating the various participants’ roles. For example, informed consent should be sought for premortem interventions to improve organ viability, and organ procurement organization personnel and members of the transplant team should not be involved in the discontinuation of life-sustaining treatment or the declaration of death. It is also important to emphasize that potential donors in cases of DCD should receive integrated interdisciplinary palliative care, including sedation and analgesia.

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“…6 If this definition is adopted, the use of circulatory support (such as extracorporeal membrane oxygenation or a heart-lung machine) after the declaration of death should, in principle, be prohibited, because circulation would effectively be restored. However, the heart is sensitive to warm ischaemia time, which should prob ably not exceed 15-20 min to protect graft 2,3,7 If heart DCDD is possible, it remains challenging, particularly if circula tory support is not used. Second, the defini tion of death could be based on brain death criteria, 8 but this approach has to be further analysed and discussed.…”

Section: Correspondencementioning

confidence: 99%