Related Experiment Video
Updated: Jul 4, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Overcoming the Boundaries of Heart Warm Ischemia in Donation After Circulatory Death: The Padua Case
Gino Gerosa1, Paolo Zanatta2, Annalisa Angelini3
1From the Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, Padova, Italy.
Insights
This study reports a successful heart transplant from a controlled donation after circulatory death (cDCD) donor for an obese patient with heart failure. The procedure highlights the viability of cDCD hearts for complex transplant candidates.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Obesity and congenital heart disease pose challenges for heart transplantation.
- Brain-dead donor availability is limited, necessitating alternative organ sources.
Observation:
- A 45-year-old obese male with heart failure was listed for heart transplantation.
- Due to anthropometric challenges, a suitable brain-dead donor was unavailable.
- The patient consented to the controlled donation after circulatory death (cDCD) program.
Findings:
- A heart was recovered following a 34-minute cardiac asystole, adhering to Italian law's 20-minute no-touch period.
- Normothermic regional perfusion (NRP) was used for heart recovery, excluding epiaortic vessels.
- The heart was preserved using cold static storage and transplanted successfully.
- Postoperative biopsies showed no rejection, and imaging confirmed normal graft function.
- The patient was discharged on postoperative day 39 in good condition.
Implications:
- Controlled donation after circulatory death (cDCD) is a viable option for heart transplantation in challenging recipients.
- Normothermic regional perfusion (NRP) can facilitate organ recovery in cDCD programs.
- This case expands the donor pool and offers hope for patients with limited traditional donor options.
Abstract:
A 45 year old male obese patient with a previous history of repaired congenital heart disease developed worsening heart failure making heart transplantation listing mandatory. Unfortunately, due to his anthropometric measures, the search for a suitable brain-dead donor was unsuccessful. For this reason, he accepted to be enrolled in the controlled donation after circulatory death (cDCD) program. According to the Italian Law regulating death declaration after cardiac arrest (no-touch period of 20 minutes-one of the longest in the world), we faced a 34 minute cardiac asystole, after which the heart was recovered through a thoraco-abdominal normothermic regional perfusion excluding the epiaortic vessels. The heart was then preserved by means of cold static storage. Heart transplantation was performed successfully without any signs of primary graft failure. Postoperative endomyocardial biopsies were negative for acute cellular and antibody-mediated rejection. Furthermore, echocardiographic and cardiac magnetic resonance evaluation of the heart did not show any functional abnormalities. The patient was discharged on post-operative day (POD) #39 in good clinical conditions.
