Related Experiment Video
Updated: Aug 3, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Donation after circulatory death heart procurement strategy impacts utilization and outcomes of concurrently procured
Jason Thomas1, Qiudong Chen1, Amy Roach1
1Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Insights
In-situ thoracoabdominal normothermic regional perfusion for donation after circulatory death (DCD) heart procurement improves DCD liver utilization and reduces delayed graft function in DCD kidneys. This technique maximizes the transplant potential of concurrently procured abdominal organs.
Area of Science:
- Transplantation immunology
- Organ procurement strategies
- Cardiovascular surgery
Background:
- Donation after circulatory death (DCD) heart procurement techniques' impact on concurrent liver and kidney utilization is unclear.
- Optimizing DCD organ utilization is crucial for addressing organ shortages.
Purpose of the Study:
- To evaluate the effect of different DCD heart procurement methods on concurrently procured DCD liver and kidney utilization and outcomes.
- To compare direct procurement versus in-situ thoracoabdominal normothermic regional perfusion for DCD heart procurement.
Main Methods:
- Utilized the United Network for Organ Sharing database (12/2019-03/2022).
- Identified DCD donors based on heart procurement technique: direct procurement (n=246) vs. in-situ perfusion (n=128).
- Assessed transplantation rates and post-transplant outcomes for concurrently procured DCD livers and kidneys.
Main Results:
- In-situ perfusion showed a higher DCD liver transplantation rate (67.1% vs 56.5%, p=0.045).
- No significant difference in 6-month liver graft failure.
- Kidneys procured with in-situ perfusion had less delayed graft function (11.3% vs 41.5%, p<0.0001), shorter hospital stays, and lower creatinine levels at discharge.
Conclusions:
- DCD heart procurement using in-situ thoracoabdominal normothermic regional perfusion increases DCD liver utilization and reduces delayed graft function in DCD kidneys.
- This technique enhances the viability and transplant potential of concurrently procured abdominal organs.
- Wider adoption of DCD heart transplantation should incorporate methods to maximize abdominal organ recovery and success.
Introduction:
The impact of donation after circulatory death (DCD) heart procurement techniques on the utilization and outcomes of concurrently procured DCD livers and kidneys remains unclear.
Methods:
Using the United Network for Organ Sharing database, we identified 246 DCD donors whose heart was procured using direct procurement and ex-situ machine perfusion and 128 DCD donors whose heart was procured using in-situ thoracoabdominal normothermic regional perfusion (12/2019-03/2022). We evaluated the transplantation rate of concurrently procured DCD livers and kidneys (defined as the number of organs transplanted/total number of organs available for procurement) and their post-transplant outcomes.
Results:
The transplantation rate of concurrently procured DCD livers was higher with in-situ perfusion compared to direct procurement (67.1% vs 56.5%, p = 0.045). After excluding pediatric, multiorgan, and repeat transplant recipients, there was no difference in 6-month liver graft failure rate (direct procurement 0.9% vs in-situ perfusion 0%, p > 0.99). Recipients of kidneys procured with in-situ perfusion had less delayed graft function (11.3% vs 41.5%, p < 0.0001) shorter length of stay, and lower serum creatinine at discharge (both p < 0.05). Six-month recipient survival in the direct procurement and in-situ perfusion group were similar after DCD liver and kidney transplantation (p = 0.24 and 0.79 respectively).
Conclusions:
Compared to direct procurement, DCD heart procurement with in-situ thoracoabdominal normothermic regional perfusion was associated with increased utilization of DCD livers and a lower incidence of delayed graft function in concurrently procured DCD kidneys. Broader implementation of DCD heart transplantation must maximize the transplant potential of concurrently procured abdominal organs and ensure their successful outcomes.
