Related Experiment Video
Updated: Jun 20, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Organ donation after cardiac determination of death (DCD): a swine model
Nabeel R Obeid1, Alvaro Rojas, Junewai L Reoma
1Department of General Surgery, University of Michigan Medical School, Michigan, USA.
Insights
This study established a swine model simulating expected Donors after Cardiac Death (e-DCD) to understand physiological changes before organ recovery. This research aids in improving organ transplantation from e-DCD donors.
Area of Science:
- Physiology
- Transplantation Medicine
- Critical Care Medicine
Background:
- Organ scarcity is a significant challenge in transplantation.
- Donors after Cardiac Death (DCD) offer a potential solution but are limited by warm ischemia time.
- Expected DCD (e-DCD) donors, those with irreversible brain injury, may mitigate warm ischemia concerns.
Purpose of the Study:
- To develop a clinically relevant animal model simulating the physiological conditions of an expected Donors after Cardiac Death (e-DCD) scenario.
- To analyze hemodynamic and pulmonary changes preceding cardiac death in a controlled setting.
- To establish a foundation for future research in organ transplantation from e-DCD donors.
Main Methods:
- Anesthetized swine underwent ventilator withdrawal and heparin administration.
- Cardiac death was defined by asystole or specific hemodynamic parameters (MAP ≤ 25 mm Hg, PP ≤ 20 mm Hg).
- Hemodynamic, pulmonary artery flow, arterial blood gas, and left atrial pressure data were recorded at 5-minute intervals.
Main Results:
- A hyperdynamic period was observed within 5 minutes of ventilator removal.
- Apneic periods were characterized by rapid hypercapnia and acidosis.
- The physiological progression included hypotension, bradycardia, and terminal arrhythmias (asystole or ventricular fibrillation).
Conclusions:
- The developed protocol accurately mimics the clinical e-DCD scenario, including physiological changes.
- This validated e-DCD model provides a platform for studying organ preservation and transplantation.
- Understanding pre-mortem physiology is crucial for optimizing organ viability from DCD donors.
Abstract:
Donors after Cardiac Death (DCD) may reduce the organ scarcity; however, their use is limited because of warm ischemia time. Fortunately, this is less important in a subclass of DCD called expected (e-DCD), those with irreversible but incomplete brain injury. This study analyzed hemodynamic/pulmonary data to establish a clinically relevant model of cardiac death that would simulate an e-DCD setting. Hemodynamics, pulmonary artery flows, arterial blood gasses, and left atrial pressure were recorded q 5 minutes in anesthetized swine. After baseline data collection, the ventilator was discontinued and heparin was administered. Cardiac death was defined: as asystole, or mean arterial presusure < or = 25 mm Hg with a pulse pressure < or = 20 mm Hg. The time to death was approximately 14.8 minutes. Within 5 minutes of removal of the ventilator, there was a hyperdynamic period. Blood gases throughout the apneic time showed a rapid hypercapnia and acidosis. The hyperdynamic reflex response was followed by hypotension, bradycardia, and finally asystole or ventricular fibrillation. The protocol of withdrawal of ventilation, systemic anticoagulation, determination of death was developed to closely resemble the clinical e-DCD scenario. The physiologic changes that happen before death in DCD were described. An e-DCD model that can be used in studies related to organ transplantation was established.
