Related Experiment Video
Updated: Nov 5, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Heart transplantation following donation after circulatory death: Expanding the donor pool
Sarah E Scheuer1, Paul C Jansz1, Peter S Macdonald1
1Cardiac Physiology & Transplantation, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, New South Wales, Australia; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, Australia.
Insights
Donation after circulatory death (DCD) heart transplantation is growing, with excellent outcomes comparable to donation after brain death (DBD) donors. DCD hearts are becoming a major global source for heart transplants.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Innovation
Background:
- Donation after circulatory death (DCD) heart transplantation is an expanding field.
- Historically, DCD heart donation faced challenges related to ischemia and viability assessment.
- Advancements in procurement and preservation have made DCD heart transplantation increasingly feasible.
Purpose of the Study:
- To review the history, challenges, and current practices of DCD heart transplantation.
- To outline procurement protocols and strategies for limiting ischemic injury.
- To assess the outcomes and future potential of DCD heart donation.
Main Methods:
- Review of existing literature on DCD heart transplantation protocols and outcomes.
- Analysis of procurement methods, including in situ and ex situ resuscitation and viability assessment.
- Comparison of outcomes between DCD and donation after brain death (DBD) heart recipients.
Main Results:
- At least three protocols exist for DCD heart resuscitation and viability assessment.
- Outcomes for DCD heart transplant recipients are excellent and comparable to DBD recipients.
- DCD heart transplantation constitutes a significant portion (one-third) of transplant activity in leading centers.
Conclusions:
- DCD heart transplantation is a viable and increasingly important source for heart donation.
- The utilization of the DCD pathway is expected to rise globally.
- DCD donors are poised to become a major source of hearts for transplantation worldwide.
Abstract:
Heart transplantation from donation after circulatory death (DCD) donors is a rapidly expanding practice. In this review, we describe the history and challenges of DCD heart transplantation and overview the procurement protocols and methods of limiting ischemic injury, current outcomes, and future directions. There are now at least three protocols that permit resuscitation and viability assessment of the DCD heart either in situ or ex situ. While the retrieval protocol for hearts from DCD donors will depend on local regulations, the outcomes of DCD heart transplant recipients reported to date are excellent regardless of the retrieval protocol and are comparable to the outcomes of heart transplant recipients from donation after brain death (DBD) donors. In the two centers with the largest published experience, DCD heart transplantation now accounts for one third of their heart transplant activity. With international trends indicating that there is an increasing utilisation of the DCD pathway, it is expected that DCD donors will become a major source of heart donation worldwide.
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