Transplantation of a heart donated after circulatory death via thoraco-abdominal normothermic regional perfusion and results from the first Spanish case

Abstract

Background Controlled donation after circulatory death (cDCD) has emerged as one of the main strategies for increasing the organ donor pool. Because of the ischemic injury that follows the withdrawal of life-sustaining therapies, hearts from cDCD donors have not been considered for transplantation until recently. The ex-situ perfusion of hearts directly procured from cDCD donors has been used to allow the continuous perfusion of the organ and the assessment of myocardial viability prior to transplantation. Based on our experience with abdominal normothermic regional perfusion in cDCD, we designed a protocol to recover and validate hearts from cDCD donors using thoraco-abdominal normothermic regional perfusion without the utilization of an ex-situ device. Case presentation We describe the first case of a cDCD heart transplant performed with this approach in Spain. The donor was a 43-year-old asthmatic female diagnosed with severe hypoxic encephalopathy. She was considered a potential cDCD donor and a suitable candidate for multiorgan procurement including the heart via thoraco-abdominal normothermic regional perfusion. The heart recipient was a 60-year-old male diagnosed with amyloid cardiomyopathy. Cold ischemia time was 55 min. The surgery was uneventful. Conclusions This case report, the first of its kind in Spain, supports the feasibility of evaluating and successfully transplanting cDCD hearts without the need for ex-situ perfusion based on the use of thoraco-abdominal normothermic regional perfusion opening the way for multiorgan donation in cDCD.

Expanding controlled donation after the circulatory determination of death: statement from an international collaborative

“…TA-NRP is being used in the UK, Belgium, and more recently in Spain as a strategy to allow the validation and preservation of hearts of cDCDD donors [63,[83][84][85][86]. In the British experience, most hearts recovered by using TA-NRP have been followed by ex situ machine perfusion.…”

“…In the Papworth technique, TA-NRP is followed by instrumentation on the OCS ™ -Heart device for transportation [82]. Successes with the TA-NRP technique followed by cold preservation and storage for transport have recently been reported by two teams in Belgium (Liège, Leuven) [83,84] and three centers in Spain [85,86].…”

Spanish heart transplant registry. 33rd official report of the Heart failure Association of the Spanish Society of Cardiology

“…However, there may still be room for improvement related to the accumulation of experience for the groups most recently adopting ventricular support programs or the expansion of donation after circulatory death. 6…”

The international experience of in-situ recovery of the DCD heart: a multicentre retrospective observational study

“…12,13 Early work on taNRP is encouraging with centres across numerous countries reporting positive outcomes. [14][15][16][17][18][19][20] However, the impact of taNRP on the outcomes of DCD donor hearts has only been described in single centre experiences with small sample sizes.…”

“…Moreover, this study contributes to a limited literature on taNRP, where so far there have only been 7 centres reporting on 53 cases between them. [14][15][16][17][18][19][20] The study had several limitations. The first is the shorter median follow-up time, especially from three years onwards where the number of censored events increases considerably.…”