Beating Heart Transplant Procedures Using Organs From Donors With Circulatory Death
Related Experiment Video
Updated: Jul 16, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Aravind Krishnan1, Chawannuch Ruaengsri1, Brandon A Guenthart1
1Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
Insights
The beating heart method for deceased donor (DCD) heart transplants is safe, showing zero need for extracorporeal membrane oxygenation post-surgery. This technique may reduce ischemia reperfusion injury, improving outcomes for DCD heart transplantation.
Area of Science:
- Cardiovascular Surgery
- Transplantation Immunology
- Organ Preservation
Background:
- Deceased after circulatory death (DCD) donors are increasingly used for heart transplantation.
- Ex vivo normothermic organ perfusion enables DCD heart use but involves ischemia, potentially increasing graft injury.
- High rates of extracorporeal membrane oxygenation (ECMO) are observed post-DCD heart transplant.
Purpose of the Study:
- To evaluate the safety of the beating heart method for DCD heart transplantation.
- To assess the postoperative rate of extracorporeal membrane oxygenation (ECMO) use in DCD heart transplantation using this technique.
Main Methods:
- A case series of 10 patients undergoing DCD heart transplantation using the beating heart implantation method.
- Data collected from October 2022 to August 2023 at a single academic medical center.
- Analysis focused on primary graft dysfunction and need for mechanical circulatory support.
Main Results:
- All 10 patients survived with 100% graft survival.
- No patients required postoperative extracorporeal membrane oxygenation (ECMO) or other mechanical circulatory support.
- The mean age of recipients was 51.2 years, with 70% having idiopathic dilated cardiomyopathy.
Conclusions:
- The beating heart implantation method for DCD heart transplantation is safe and effective.
- This technique may mitigate ischemia reperfusion injury, potentially reducing primary graft dysfunction and ECMO requirement.
- Findings are relevant for centers utilizing DCD donors for heart transplantation.
Importance:
The use of ex vivo normothermic organ perfusion has enabled the use of deceased after circulatory death (DCD) donors for heart transplants. However, compared with conventional brain death donation, DCD heart transplantation performed with ex vivo organ perfusion involves an additional period of warm and cold ischemia, exposing the allograft to multiple bouts of ischemia reperfusion injury and may contribute to the high rates of extracorporeal membrane oxygenation usage after DCD heart transplantation.
Objective:
To assess whether the beating heart method of DCD heart transplantation is safe and whether it has an acceptable rate of extracorporeal membrane oxygenation use postoperatively.
Design, Setting, And Participants:
This case series includes 10 patients with end-stage heart failure undergoing DCD heart transplantation at a single academic medical center from October 1, 2022, to August 3, 2023. Data were analyzed from October 2022 to August 2023.
Interventions:
Using a beating heart method of implantation of the donor allograft.
Main Outcomes And Measures:
The main outcome was primary graft dysfunction necessitating postoperative initiation of mechanical circulatory support. Survival and initiation of mechanical circulatory support were secondary outcomes.
Results:
In this case series, 10 consecutive patients underwent DCD heart transplantation via the beating heart method. Ten of 10 recipients were male (100%), the mean (SD) age was 51.2 (13.8) years, and 7 (70%) had idiopathic dilated cardiomyopathy. Ten patients (100%) survived, and 0 patients had initiation of extracorporeal membrane oxygenation postoperatively. No other mechanical circulatory support, including intra-aortic balloon pump, was initiated postoperatively. Graft survival was 100% (10 of 10 patients), and, at the time of publication, no patients have been listed for retransplantation.
Conclusions And Relevance:
In this study of 10 patients undergoing heart transplantation, the beating heart implantation method for DCD heart transplantation was safe and may mitigate ischemia reperfusion injury, which may lead to lower rates of primary graft dysfunction necessitating extracorporeal membrane oxygenation. These results are relevant to institutions using DCD donors for heart transplantation.
