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Donation after circulatory death heart transplantation
Kumud K Dhital1, Hong C Chew, Peter S Macdonald
1aHeart Transplant Unit, St Vincent's Hospital bVictor Chang Cardiac Research Institute cUniversity of New South Wales, Sydney, New South Wales, Australia.
Current Opinion in Organ Transplantation
|April 6, 2017
Summary
Donation after circulatory death (DCD) heart transplantation is now feasible, offering excellent early outcomes. This approach addresses the critical donor heart shortage, making DCD heart utilization increasingly justifiable.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Significant disparity exists between donor heart supply and recipient demand.
- Extended-criteria donor hearts are increasingly utilized, but shortages persist.
- Donation after circulatory death (DCD) heart transplantation was not previously feasible.
Purpose of the Study:
- To review advances in translational research for DCD heart transplantation.
- To provide an update on the clinical adoption of DCD heart donation pathways.
Main Methods:
- Utilized ex-situ transportable cardiac perfusion platforms.
- Employed modified cardioplegia and postconditioning agents.
- Implemented direct procurement with ex-situ perfusion or in-situ reanimation followed by ex-situ perfusion.
Main Results:
- Successful transplantation of distantly procured human DCD hearts reported by three centers.
- Demonstrated feasibility of DCD heart procurement and transplantation.
- Achieved excellent early outcomes in DCD heart recipients.
Conclusions:
- DCD heart transplantation is a viable option with promising early results.
- The donor organ shortage makes rejecting suitable DCD hearts difficult to justify.
- This pathway offers a solution to waitlist attrition and organ scarcity.