Successful Combined Heart-Lung Transplant from a Donation after Circulatory Determined Death (DCD) Donor

Abstract

For patients with end stage heart failure and fixed pulmonary hypertension, combined heart-lung transplantation offers the only possibility of survival with a return to a normal quality of life. Unfortunately, due to the severe scarcity of donation after brain death (DBD) organs it is rarely performed. We present the first successful combined heart lung transplant from a DCD donor. A 24-year-old male born with transposition of the great arteries, pulmonary stenosis and a ventricular septal defect (VSD) was operated in childhood with the arterial switch operation and closure of VSD. He continued to suffer with pulmonary hypertension in childhood treated with pulmonary vasodilators. He was referred to our institute in decompensated heart failure and listed for combined heart and lung transplantation, (table 1). After 3 months on the urgent list with no suitable DBD donor offers, the possibility of DCD transplantation was discussed. He matched for a DCD heart-lung bloc 109 days after his original listing and 17 days after listing for a DCD organ. The donor was a 29 year old male motorcyclist who suffered a 30 minute hypoxic cardiac arrest following a road traffic accident (table 1). The potential donor was treated for Staphylococcus aureus pneumonia and was ventilated for 12 days in ITU until futility was declared. Death was declared 219 minutes following withdrawal with a functional warm ischaemic time of 41 minutes. The heart heart and lungs were removed en bloc and perfused together on an in house modified Transmedics OCS lung device for 8 hours 2 minutes. Post transplant the recipient weaned off cardiopulmonary bypass without difficulty. He was discharged home in the 7th post-operative week and remains well at home 3 months following his transplant. DCD heart-lung transplantation has the potential for the increasing number of young adult congenital heart failure patients bridged through childhood with palliative surgical procedures in urgent need of transplantation.