Heart Transplantation Using Donors after Circulatory Death: From Research to Clinical Practice

Abstract

Donation after circulatory death for heart transplantation was abandoned in the 1970s with the advent of the brain death law (donation after brain death), where the donor heart is beating and perfused up to the moment prior to organ retrieval. Shortage of donors has renewed the interest in animal and clinical research of donors after circulatory death for heart transplantation, aiming at optimizing heart function after the period of oxygen deprivation caused by severe hypotension and subsequent circulatory arrest. This study presents the initial experience with donation after circulatory death for heart transplantation at our institution. Papworth Hospital has performed a successful clinical investigation in which ten cardiac transplants were performed with hearts from donation after circulatory death, without mortality. Low risk recipients who had previously signed their consent were chosen. Most hearts from donation after circulatory death were reperfused with an extracorporeal circulation device, and following weaning from the circulatory support the heart was harvested and connected to the perfusion machine for transportation and simultaneous assessment of function before implantation. In conclusion, this technique could be used for cardiac transplantation with satisfactory outcomes.