Abstract
There is an epidemic of advanced heart failure across developed countries. For those who are refractory to medical and/or device therapies, cardiac replacement can improve quality of life and life expectancy. Fifty years on from the first successful human case, heart transplantation remains the most effective treatment for advanced heart failure with Conventionally, only hearts from donation after brain dead (DBD) are considered for transplantation. After careful assessment, 25% to 30% of DBD hearts go on to be retrieved and transplanted. The rest are declined due to donor medical history, poor function, coronary artery disease, hypertrophy etc. The challenge over the last decade has been to increase DBD heart utilisation and to identify other donor pools. In recent years, targeted early donor management of DBD donors by a member of the cardiothoracic retrieval team at the donor ICU, or ‘scouting’, has been shown to increase the percentage of DBD hearts retrieved and transplanted.1 The other major development has been the use of reconditioned asystolic hearts from donation after circulatory death (DCD). Here, withdrawal of life supporting therapy results in hypoventilation, hypoxia and systemic hypotension. Eventually, profound cardiac ischaemia results in cardiac arrest. After a mandatory observation period of five or more minutes, death is legally confirmed. A combination of in-situ and ex-situ perfusion techniques have been successfully used to re-animate asystolic DCD hearts for consideration of transplantation.2 3 References . Retrieval team initiated early donor management (scouting) increases donor heart acceptance rate for transplantation. J Heart Lung Transplant2016;35:S220. http://dx.doi.org/10.1016/j.healun.2016.01.620 . Functional assessment and transplantation of the donor heart after circulatory death. J Heart Lung Transplant2016;35:1443–1452. . Outcome following heart transplantation from donation after circulatory determined death (DCD) donors. http://dx.doi.org/10.1016/j.healun.2017.10.021
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