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Updated: Apr 18, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Ex vivo heart perfusion after cardiocirculatory death; a porcine model
Diana García Sáez1, Ahmed Elbetanony2, Paul Lezberg2
1Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital NHS Foundation Trust, Harefield, United Kingdom.
Insights
Hearts from donation after cardiocirculatory death (DCD) donors can be resuscitated using the Organ Care System (OCS). This study shows DCD hearts can be assessed ex vivo for transplant suitability.
Area of Science:
- Cardiovascular Research
- Transplantation Medicine
- Organ Preservation
Background:
- Donation after cardiocirculatory death (DCD) increases organ availability but heart transplantation faces challenges.
- Ex vivo assessment of DCD hearts is crucial for expanding donor pools.
- The Organ Care System (OCS) offers a novel approach for heart preservation and evaluation.
Purpose of the Study:
- To investigate the feasibility of ex vivo resuscitation and assessment of porcine hearts from DCD donors.
- To evaluate the use of the Organ Care System (OCS) in a simulated clinical transplantation scenario.
- To determine the viability of DCD porcine hearts for transplantation after ex vivo assessment.
Main Methods:
- Induction of cardiocirculatory death in pigs followed by a 15-minute warm ischemia period.
- Procurement of hearts and immediate implantation into the Organ Care System (OCS) for ex vivo assessment.
- Ex vivo evaluation of hearts over 4 hours, assessing contractility and lactate trends.
Main Results:
- Four out of five porcine hearts were successfully resuscitated on the OCS.
- Three hearts demonstrated excellent contractility and lactate trends, deemed transplantable.
- One heart with a longer agonal time (48 minutes) could not be resuscitated.
Conclusions:
- Porcine hearts from nonheparinized DCD donors can be successfully resuscitated using the OCS.
- The OCS provides a viable platform for assessing DCD heart transplantability under simulated clinical conditions.
- This approach holds promise for increasing the utilization of DCD donor hearts in transplantation.
Background:
Donation after cardiocirculatory death (DCD) has lead to an increase in organ availability. However, because of medical, logistic, and ethical issues, the use of hearts from DCD donors for transplantation is not generally considered to be feasible. In this study, we investigated the feasibility of ex vivo resuscitation and assessment of the porcine heart after circulatory death using the organ care system (OCS).
Methods:
Cardiocirculatory death was induced in five pigs by cessation of mechanical ventilation. No heparin was administered. The agonal time (AT) was calculated as the time between a reduction of blood pressure <50 mm Hg or a fall in saturation beneath 70% and the cessation of electrical activity. After a further 15 min of warm ischemia, hearts were procured and implanted into the OCS, mimicking the actual clinical scenario for other organs. Thus, procured grafts were assessed ex vivo over a period of 4 h.
Results:
Four hearts were successfully resuscitated on the system (AT 8, 15, 20, and 34 min) Three grafts had excellent visual contractility and lactate trends and were considered to be transplantable. One graft (AT 34 min) had an increased lactate and abnormal contractility being unsuitable for transplantation. One heart with 48-min AT could not be resuscitated.
Conclusions:
Our data show that hearts from nonheparinized DCD porcine donors can be successfully resuscitated using the OCS in a scenario, which closely simulates clinical conditions.
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