Abstract
BackgroundControlled 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 presentationWe 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.ConclusionsThis 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.
Highlights
Controlled donation after circulatory death has emerged as one of the main strategies for increasing the organ donor pool
This case report, the first of its kind in Spain, supports the feasibility of evaluating and successfully transplanting Controlled donation after circulatory death (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
Controlled donation after circulatory death refers to the donation from individuals who have been declared dead following the decision for the withdrawal of life-sustaining therapies (WLST) that are no longer considered beneficial to patients with devastating brain injury or terminal lung, heart and neurodegenerative diseases [1]. cDCD is one of the most robust strategies for increasing the organ donor pool and is carried out in a growing number of countries throughout the world [2]. cDCD was implemented in Spain approximately 10 years ago
Summary
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.
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