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Published on: August 15, 2022
Heart Donation From Donors After Controlled Circulatory Death
Laura Anguela-Calvet1,2, Gabriel Moreno-Gonzalez1,2,3, Fabrizio Sbraga4
1Intensive Care Department, Hospital Universitari de Bellvitge, Barcelona, Spain.
Insights
Donation after circulatory death (DCD) heart transplants are expanding globally to increase donor availability. This review covers cDCD heart retrieval, injury management, and transplantation strategies for improved outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Innovation
Background:
- Cardiac transplantation is the gold standard for advanced heart failure.
- Historically, heart donors were primarily from brain death donors.
- Donation after circulatory death (DCD) is increasingly vital to expand the donor pool.
Purpose of the Study:
- To review the current literature on controlled donation after circulatory death (cDCD) heart transplantation.
- To summarize the pathophysiology of ischemia-reperfusion injury in cDCD hearts.
- To outline heart retrieval techniques and damage mitigation strategies for cDCD donors.
Main Methods:
- Concise literature review of cDCD heart transplant studies.
- Summary of pathophysiological mechanisms.
- Description of retrieval techniques and preservation strategies.
Main Results:
- cDCD heart transplant programs are established in several countries, including the UK, USA, and Spain.
- Understanding ischemia-reperfusion injury is crucial for successful cDCD heart transplantation.
- Various retrieval and preservation strategies aim to minimize damage to cDCD donor hearts.
Conclusions:
- Heart transplantation using DCD hearts is a continuously improving field.
- Implementation in experienced cardiac transplant centers is recommended for successful cDCD heart programs.
- cDCD offers a promising avenue to increase heart availability for transplantation.
Abstract:
The gold-standard therapy for advanced-stage heart failure is cardiac transplantation. Since the first heart transplant in 1967, the majority of hearts transplanted came from brain death donors. Nevertheless, in recent years, the option of donation after circulatory death (DCD) is gaining importance to increase donor pool. Currently, heart-transplant programs using controlled donation after circulatory death (cDCD) have been implemented in the United Kingdom, Belgium, Australia, United States of America, and, recently, in Spain. In this article, we performed a concise review of the literature in heart cDCD; we summarize the pathophysiology involved in ischemia and reperfusion injury during this process, the different techniques of heart retrieval in cDCD donors, and the strategies that can be used to minimize the damage during retrieval and until transplantation. Heart transplant using DCD hearts is in continuous improvement and must be implemented in experienced cardiac transplant centers.
