Related Experiment Video
Updated: Oct 26, 2025
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Early US experience with cardiac donation after circulatory death (DCD) using normothermic regional perfusion
Jordan R H Hoffman1, William G McMaster1, Aniket S Rali2
1Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Donation after circulatory death (DCD) hearts can increase transplant availability. Thoracic normothermic regional perfusion (TA-NRP) and cold static storage enabled extended cold ischemic times for DCD allografts, facilitating inter-hospital transport.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Organ Procurement
Background:
- Significant shortage of suitable donor hearts for cardiac transplantation.
- Increasing interest in Donation after Circulatory Death (DCD) as a potential source for cardiac allografts.
- Initiation of DCD donor heart procurement at the institution.
Purpose of the Study:
- To evaluate the feasibility and outcomes of cardiac transplantation using DCD allografts.
- To assess the efficacy of a modified thoracic normothermic regional perfusion (TA-NRP) technique for DCD heart procurement.
- To determine the safety and viability of DCD allografts transported using cold static storage.
Main Methods:
- Procurement of cardiac allografts from 15 DCD donors between October 2020 and March 2021.
- Utilization of a modified extracorporeal membrane oxygenation circuit for thoracic normothermic regional perfusion (TA-NRP).
- Transport of allografts using cold static storage; data collected and analyzed with IRB approval.
Main Results:
- Mean donor age 23 ± 7 years; average TA-NRP time 56 ± 8 minutes.
- Total ischemic time averaged 183 ± 31 minutes; average transport distance 373 ± 203 nautical miles.
- Post-transplant outcomes included mild (40%) or moderate (20%) primary graft dysfunction (PGD-LV); all recipients had LVEF >55% and were alive past 30 days.
Conclusions:
- Cardiac DCD offers a viable strategy to expand the donor heart pool for transplantation.
- The TA-NRP technique combined with cold static storage effectively preserves DCD allografts.
- Extended cold ischemic times (nearly 3 hours) are achievable, facilitating inter-hospital organ transport.
Background:
Given the shortage of suitable donor hearts for cardiac transplantation and the growing interest in donation after circulatory death (DCD), our institution recently began procuring cardiac allografts from DCD donors.
Methods:
Between October 2020 and March 2021, 15 patients with heart failure underwent cardiac transplantation using DCD allografts. Allografts were procured using a modified extracorporeal membrane oxygenation circuit for thoracic normothermic regional perfusion (TA-NRP) and were subsequently transported using cold static storage. Data collection and analysis were performed with institutional review board approval.
Results:
The mean age of the DCD donors was 23 ± 7 years and average time on TA-NRP was 56 ± 8 minutes. Total ischemic time was 183 ± 31 minutes and distance from transplant center was 373 ± 203 nautical miles. Recipient age was 55 ± 14 years, with 8 (55.3%) recipients on durable left ventricular assist device support. Post-transplant, 6 (40%) recipients experienced mild left ventricle primary graft dysfunction (PGD-LV), 3 (20%) recipients experienced moderate PGD-LV, and no recipients experienced severe PGD-LV. Postoperative transthoracic echocardiogram demonstrated left ventricular ejection fraction >55% in all recipients. One recipient (6.6%) developed International Society for Heart and Lung Transplantation 2R acute cellular rejection on first biopsy. At last follow-up, all 15 recipients were alive past 30-days.
Conclusions:
Cardiac DCD provides an opportunity to increase the availability of donor hearts for transplantation. Utilizing TA-NRP with cold static storage, we have extended the cold ischemic time of DCD allografts to almost 3 hours, allowing for inter-hospital organ transport.
More Related Videos
09:54Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
06:40A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025