Related Experiment Video
Updated: May 1, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Heart transplantation with donation after circulatory determination of death
Sarah L Longnus1, Veronika Mathys1, Monika Dornbierer1
1Department of Cardiovascular Surgery, Inselspital, Berne University Hospital and University of Berne, Murtenstrasse 35, CH-0310, Switzerland.
Insights
Donation after circulatory determination of death (DCDD) could increase organ availability for heart transplantation. Careful clinical development is needed to manage warm ischaemia and ensure successful DCDD heart transplants.
Area of Science:
- Cardiology
- Transplantation Surgery
- Organ Donation
Background:
- Heart transplantation faces a critical organ shortage, leading to significant waiting-list mortality.
- Donation after circulatory determination of death (DCDD) presents a potential solution to increase organ availability for adult and pediatric recipients.
Purpose of the Study:
- To evaluate the potential of DCDD for heart transplantation.
- To address the challenges posed by warm ischaemia in DCDD heart procurement.
Main Methods:
- Review of current practices in organ donation and transplantation.
- Analysis of the physiological impact of warm ischaemia on the heart.
- Examination of the need for specific clinical protocols for DCDD heart transplantation.
Main Results:
- DCDD could substantially improve the supply of donor hearts.
- Warm ischaemia is a significant concern, but the heart can tolerate limited periods.
- Current procurement protocols are not optimized for DCDD, necessitating new approaches.
Conclusions:
- Developing specific clinical protocols and ethical frameworks for DCDD heart transplantation is crucial.
- DCDD offers a promising avenue to overcome organ shortages in heart transplantation.
- Further research and clinical adaptation are required for successful DCDD implementation.
Abstract:
The constant shortage of available organs is a major obstacle and limiting factor in heart transplantation; the discrepancy between the number of donors and potential recipients leads to waiting-list mortality of 10-12% per year in Europe and the USA. If adopted for heart transplantation, donation after circulatory determination of death (DCDD) would be expected to improve the availability of organs substantially for both adults and children. With DCDD, however, hearts to be transplanted undergo a period of warm ischaemia before procurement, which is of particular concern because tissue damage occurs rapidly and might be sufficient to preclude transplantation. Nonetheless, the heart is able to withstand limited periods of warm ischaemia, which could provide a window of opportunity for DCDD. Development of clinical approaches specifically for DCDD is critical for the exploitation of these organs, because current practices for donor heart procurement, evaluation, and storage have been optimized for conventional donation after brain death, without consideration of warm ischaemia before organ procurement. Establishment of clinical protocols and ethical and legal frameworks for DCDD of other organs is underway. This Review provides a timely evaluation of the potential for DCDD in heart transplantation.
