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Updated: Aug 15, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Potential suitability for transplantation of hearts from human non-heart-beating donors: data review from the Gift of
Arun K Singhal1, John D Abrams, Jun Mohara
1Division of Cardiac and Thoracic Surgery, Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
Insights
Utilizing hearts from non-heart-beating donors (NHBDs) could increase heart transplantation by 4-6%. This study found 12-18% of NHBDs met criteria for potential heart donation, addressing organ shortages.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Organ availability critically limits heart transplantation for end-stage heart disease.
- Current heart procurement relies on brain-dead donors (HBDs).
- Hearts from non-heart-beating donors (NHBDs) are typically deemed unusable due to potential peri-mortem ischemic injury.
Purpose of the Study:
- To project the potential increase in heart donation through the utilization of NHBD hearts.
- To evaluate the feasibility of using NHBD hearts by assessing donor criteria and ischemic times.
Main Methods:
- Retrospective review of donor databases from 2001-2003.
- Screening of NHBD population using conservative criteria, including a 30-minute acceptable hypoxic/ischemic time.
- Analysis of donor demographics, age, and data completeness.
Main Results:
- 119 NHBDs were identified during the study period.
- 14 NHBDs met all cardiac donor criteria with hypoxic/ischemic times ≤30 minutes.
- An estimated 7 additional potential donors were identified from NHBDs with incomplete data.
Conclusions:
- 12% to 18% of NHBDs were potential heart donors, representing a 4% to 6% increase in heart transplants.
- NHBD hearts offer a viable option to mitigate the donor organ shortage.
- Careful donor selection and adherence to ischemic time limits are crucial for NHBD heart utilization.
Background:
Organ availability limits use of heart transplantation for treatment for end-stage heart disease. Hearts are currently obtained from donors declared brain dead (heart-beating donors [HBDs]). Although use of hearts from non-heart-beating donors (NHBDs) could reduce the shortage, they are considered unusable because of possible peri-mortem ischemic injury.
Methods:
To project how use of NHBD hearts could increase heart donation, we retrospectively reviewed donor databases from the Gift of Life Donor Program (GLDP), our local organ procurement organization, from 2001 through 2003. We screened the NHBD population using conservative donor criteria, assuming an acceptable hypoxic/ischemic time (time from withdrawal of care to cross-clamp) of 30 minutes.
Results:
During the study period, there were 894 HBDs, 334 heart transplants and 119 NHBDs. NHBDs were similar to HBDs with respect to gender and ethnicity, but NHBDs were proportionately younger. Of 119 NHBDs, 55 did not meet the age criteria (< or =45 years) and 20 were eliminated because of incomplete data. Eighty-two NHBDs were cross-clamped within 30 minutes of care withdrawal. Twenty NHBDs met all cardiac donor criteria, and 14 of these 20 had hypoxic/ischemic times < or =30 minutes. Pro rata estimation for the 20 NHBDs with incomplete data suggested 7 potential additional donors.
Conclusions:
Based on our assumptions, 12% to 18% of NHBDs in the study period (14 to 21 of 119 total) were potential heart donors, representing a 4% to 6% increase over of the number of heart transplants performed during the same time interval.
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