Related Experiment Video
Updated: May 31, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Hearts from DCD donors display acceptable biventricular function after heart transplantation in pigs
Insights
Donors after circulatory death (DCD) hearts may be suitable for transplantation. A large animal model showed DCD hearts maintained viability and recovered function comparable to brainstem death donors, suggesting potential for clinical use.
Area of Science:
- Cardiology
- Transplantation Immunology
- Organ Preservation
Background:
- Cardiac transplantation numbers are declining, unlike other solid organs utilizing donors after circulatory death (DCD).
- Current utilization of DCD hearts is limited by concerns of irreversible injury and poor graft function.
- Investigating DCD heart viability is crucial for expanding organ donor pools.
Purpose of the Study:
- To test the hypothesis that hearts from DCD donors are suitable for transplantation.
- To assess the functional recovery and viability of DCD hearts in a large animal model.
- To compare DCD heart outcomes with those from brainstem death (BSD) donors.
Main Methods:
- A large animal model was used, subjecting donor pigs to either DCD (hypoxic cardiac arrest, 15 min warm ischemia, cardiopulmonary bypass resuscitation) or BSD (intracerebral balloon inflation).
- Cardiac function was evaluated using load-independent measures, MRI, and MRS.
- Metabolic changes (phosphocreatine, inorganic phosphate) were monitored during ischemia and reperfusion.
Main Results:
- Post-resuscitation, DCD hearts exhibited near-normal contractility with reduced stroke volume, comparable to BSD hearts.
- Metabolically, DCD hearts showed a transient decline in phosphocreatine and increase in inorganic phosphate during hypoxia, returning to baseline post-reperfusion.
- Following transplantation, cardiac function in DCD hearts was comparable to BSD hearts.
Conclusions:
- In a large animal model, DCD hearts demonstrate preserved viability and functional recovery similar to BSD hearts.
- DCD hearts show potential suitability for clinical transplantation.
- Further research into optimal reperfusion strategies for DCD hearts is warranted.
Abstract:
Cardiac transplantation is in decline, in contrast to other solid organs where the number of solid organ transplants from donors after circulatory death (DCD) is increasing. Hearts from DCD donors are not currently utilized due to concerns that they may suffer irreversible cardiac injury with resultant poor graft function. Using a large animal model, we tested the hypothesis that hearts from DCD donors would be suitable for transplantation. Donor pigs were subjected to hypoxic cardiac arrest (DCD) followed by 15 min of warm ischemia and resuscitation on cardiopulmonary bypass, or brainstem death (BSD) via intracerebral balloon inflation. Cardiac function was assessed through load-independent measures and magnetic resonance imaging and spectroscopy. After resuscitation, DCD hearts had near normal contractility, although stroke volume was reduced, comparable to BSD hearts. DCD hearts had a significant decline in phosphocreatine and increase in inorganic phosphate during the hypoxic period, with a return to baseline levels after reperfusion. After transplantation, cardiac function was comparable between BSD and DCD groups. Therefore, in a large animal model, the DCD heart maintains viability and recovers function similar to that of the BSD heart and may be suitable for clinical transplantation. Further study is warranted on optimal reperfusion strategies.
