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Updated: Nov 11, 2025
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
New Approaches to Donor Selection and Preparation in Heart Transplantation
Calvin K W Tong1, Kiran K Khush1
1Cardiovascular Medicine, Stanford University, 300 Pasteur Drive, Falk CVRC 263, Stanford, CA 94305 USA.
Insights
Expanding the donor heart pool is crucial for heart transplantation. Utilizing marginal donor hearts, ex vivo perfusion, and donation after circulatory death offers comparable outcomes and increases organ availability.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Increasing survival rates in stage D heart failure patients elevate the demand for heart transplants.
- The limited supply of donor hearts necessitates strategies to expand the donor pool.
- Marginal donor hearts, previously excluded, are now being reconsidered.
Purpose of the Study:
- To review strategies and new technologies for expanding the donor heart pool.
- To discuss the safe liberalization of donor heart acceptance criteria.
- To evaluate the outcomes of utilizing marginal donor hearts and novel preservation techniques.
Main Methods:
- Review of recent data on the use of donor hearts with risk factors (age, size mismatch, ischemia time, hypertrophy, infections).
- Analysis of outcomes associated with temperature-controlled transport and ex vivo cardiac perfusion.
- Evaluation of data from donation after circulatory death (DCD) donors compared to donation after brain death (DBD) donors.
Main Results:
- Donor hearts with risk factors can be safely utilized by liberalizing acceptance criteria.
- Ex vivo cardiac perfusion and advanced transport systems show promising short- to intermediate-term outcomes, improving preservation and reducing cold ischemic time.
- Hearts from DCD donors demonstrate outcomes comparable to those from DBD donors, significantly expanding the potential donor pool.
Conclusions:
- Careful selection and utilization of marginal donor hearts can increase transplant availability.
- Ex vivo cardiac perfusion and DCD offer viable alternatives to expand the cardiac donor pool.
- These approaches may provide comparable outcomes to conventional methods, addressing the organ shortage crisis.
Purpose Of Review:
With increasing survival of patients with stage D heart failure, the demand for heart transplantation has increased. The supply of donor hearts remains relatively limited. Strategies have been investigated and new technologies have been developed to expand the current donor pool. These new approaches will be discussed herein.
Recent Findings:
Donor hearts are often considered "marginal" due to risk factors such as older age, size mismatch with the intended recipient, prolonged ischemic time, presence of left ventricular hypertrophy, and hepatitis B/C infection. We reviewed recent data regarding the use of donor hearts with these risk factors and suggest ways to safely liberalize current donor heart acceptance criteria. New technologies such as temperature-controlled transport systems and ex vivo cardiac perfusion methods have also demonstrated promising short-term and intermediate outcomes as compared with routine cold storage, by promoting heart preservation and enabling heart procurement from remote sites with shorter cold ischemic time. Recent use of hearts from donation after circulatory death donors has demonstrated comparable outcomes to conventional donation after brain death, which can further expand the current donor pool.
Summary:
Careful selection of "marginal" donor hearts, use of ex vivo cardiac perfusion, and acceptance of hearts after circulatory death may expand our current cardiac donor pool with comparable outcomes to conventional donor selection and preparation methods.
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