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A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
The Future of heart procurement with donation after circulatory death: Current practice and opportunities for
Austin Ayer1, Jacob N Schroder2, Sarah Casalinova2
1Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Insights
Expanding heart donation after circulatory death (DCD) transplantation requires addressing key procurement questions. Research and consensus on DCD heart procurement best practices are vital for increasing heart transplant availability.
Area of Science:
- Cardiology
- Transplantation Surgery
- Organ Donation
Background:
- Heart donation after circulatory death (DCD) offers significant potential to increase heart transplantation rates.
- Current expansion is hindered by unresolved questions regarding optimal DCD heart procurement practices.
- Variability exists in regulatory frameworks, guidelines, and published DCD procurement procedures.
Purpose of the Study:
- To outline current practices in DCD heart procurement.
- To identify and discuss critical outstanding questions in DCD heart procurement.
- To facilitate advancements in DCD heart transplantation through research and consensus.
Main Methods:
- Review of current practices in DCD heart procurement.
- Identification of key areas requiring further investigation.
- Discussion of fundamental aspects including donor selection, premortem interventions, and procurement techniques.
Main Results:
- Current DCD heart procurement practices are described.
- Key areas of uncertainty are highlighted, including donor selection, ischemic definitions, and preservation techniques.
- Variability in regulatory and professional guidelines is noted.
Conclusions:
- Addressing fundamental questions in DCD heart procurement is crucial.
- Research and consensus recommendations are needed to standardize practices.
- Advancing DCD heart procurement will expand heart transplantation opportunities.
Abstract:
Heart Donation after Circulatory Death (DCD) has the potential to significantly increase the number of patients benefitting from heart transplantation. However, the expansion of DCD heart transplantation is currently limited by unanswered questions pertaining to best practices in DCD heart procurement. Additionally, significant variability exists within regulatory frameworks, professional guidelines, and published practices of DCD procurement processes. Here we describe the current practice and outstanding questions related to fundamental aspects of DCD heart procurement, including donor selection, premortem donor intervention, ischemic definitions, confirmation of circulatory death, and techniques for heart procurement and preservation. Addressing these key issues through research and consensus recommendations will facilitate the advancement of the field and ultimately expand the opportunity for heart transplantation to a greater number of patients.
