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Updated: Jul 19, 2025
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Dilemmas concerning heart procurement in controlled donation after circulatory death
S E Kaffka Genaamd Dengler1, M T Vervoorn1, M Brouwer1
1Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Insights
The demand for donor hearts for transplantation exceeds supply. Utilizing hearts from circulatory death donors, using direct procurement or normothermic regional perfusion, addresses this shortage but raises ethical questions regarding the dead donor rule.
Area of Science:
- Cardiology
- Transplantation Medicine
- Bioethics
Background:
- Increasing heart failure prevalence drives demand for heart transplantation.
- Donor heart supply is insufficient to meet transplantation needs.
- Circulatory death donation offers a solution to the organ shortage.
Purpose of the Study:
- To discuss current heart procurement protocols for circulatory death donors.
- To explore ethical considerations surrounding normothermic regional perfusion.
- To analyze dilemmas in heart procurement from circulatory death donors.
Main Methods:
- Review of established heart procurement techniques.
- Analysis of ethical frameworks, including the dead donor rule.
- Discussion of direct procurement and perfusion versus thoraco-abdominal normothermic regional perfusion.
Main Results:
- Direct procurement is an accepted method for heart retrieval from circulatory death donors.
- Normothermic regional perfusion presents ethical challenges related to the dead donor rule.
- Divergent ethical viewpoints exist regarding these procurement protocols.
Conclusions:
- Heart transplantation faces organ shortages, necessitating innovative donor strategies.
- Procurement protocols for circulatory death donors require careful ethical evaluation.
- Balancing organ availability with ethical principles is crucial in transplantation.
Abstract:
With an expanding population at risk for heart failure and the resulting increase in patients admitted to the waiting list for heart transplantation, the demand of viable organs exceeds the supply of suitable donor hearts. Use of hearts after circulatory death has reduced this deficit. Two primary techniques for heart procurement in circulatory death donors have been described: direct procurement and perfusion and thoraco-abdominal normothermic regional perfusion. While the former has been accepted as an option for heart procurement in circulatory death donors, the latter technique has raised some ethical questions in relation to the dead donor rule. In this paper we discuss the current dilemmas regarding these heart procurement protocols in circulatory death donors.
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