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Updated: Nov 30, 2025
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Combined Assessment of Functional and Metabolic Performance of Human Donor Hearts: Possible Application in Donation
Prasanna Bhaskaran1,2, Ruchong Ou3, Silvana Marasco1,3
1Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, Australia.
Insights
A new intraventricular balloon method effectively measures donor heart contractility, aiding in the assessment of Donation after Circulatory Death (DCD) hearts for transplantation when combined with lactate metabolism analysis.
Area of Science:
- Cardiovascular Surgery
- Organ Transplantation
- Physiology
Background:
- Donation after Circulatory Death (DCD) is a growing source of organs for transplantation.
- Assessing the suitability of DCD hearts poses a significant challenge.
- Contractile function is the key determinant of organ recovery and viability.
Purpose of the Study:
- To develop and evaluate a novel technique for measuring donor heart contractility.
- To compare the novel technique with lactate metabolism assessment for DCD heart evaluation.
- To determine the potential application of this technique in heart transplantation.
Main Methods:
- Human DCD and donation after brain death hearts were preserved and perfused ex vivo.
- Intraventricular balloons were used to measure left and right ventricular developed pressure (LVDP/RVDP).
- Lactate levels in perfusate were measured to assess metabolic function.
Main Results:
- Contractile function (LVDP) and lactate metabolism were concordant in 7 out of 12 hearts.
- Discordant results were observed in 5 hearts, indicating potential limitations of lactate alone.
- The novel balloon technique provided valuable contractile data.
Conclusions:
- The intraventricular balloon technique offers valuable insights into donor heart contractile recovery.
- Combining this technique with lactate metabolism can improve the evaluation of DCD and marginal donor hearts.
- This method has potential applications for pre-transplant assessment of donor hearts.
Background:
Donation after circulatory death (DCD) represents an increasing source of organs. However, evaluating the suitability of DCD hearts for transplantation represents a challenge. Contractile function is the ultimate determinant of recovery. We developed a novel technique in an ex vivo rig for the measurement of contractility using intraventricular balloons. We compared this technique with the measurement of lactate metabolism, the current gold standard.
Methods:
Human DCD (n = 6) and donation after brain death (n = 6) hearts were preserved by perfusion with a cold oxygenated crystalloid solution for 4 h, transferred to a blood perfusion rig at 37 °C where balloons were inserted into the left (LV) and right (RV) ventricles to measure developed pressure (DP = systolic minus diastolic). Perfusate lactate levels were measured for metabolic assessment. Concordance between LVDP and lactate was assessed during 4 h using cutoffs for LVDP of 70 mm Hg and for lactate of 10 mmol/L.
Results:
Measurements of contractile function (LVDP) and metabolism (lactate levels) were deemed concordant in 7 hearts with either a high LVDP (mean 100 mm Hg) with low lactate (mean 6.7 mmol/L)) or a low LVDP (15 mm Hg) with high lactate (mean 17.3 mmol/). In the remaining 5 hearts, measurements were deemed discordant: 4 hearts had high LVDP (mean 124 mm Hg), despite high lactate levels 17.3 mmol/L) and 1 had low LVDP (54 mm Hg) but low lactate (6.9 mmol/L).
Conclusions:
The intraventricular balloon technique provides useful information regarding contractile recovery of donor hearts that if combined with lactate metabolism has potential application for the evaluation of DCD and marginal donation after brain death hearts before transplant.
