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Updated: Jun 21, 2025
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Donation After Circulatory Death Heart Transplantation: A Narrative Review
Kristin Constantine Trela1, Christopher T Salerno2, Emuejevoke Chuba3
1Department of Anesthesia and Critical Care Medicine, University of Chicago, Chicago, IL, United States.
Insights
Donation after circulatory death (DCD) heart transplantation expands the donor pool for end-stage heart failure patients. Advancements in procurement and preservation strategies are improving outcomes, offering new hope for recipients.
Area of Science:
- Cardiology
- Transplantation Surgery
- Organ Donation
Background:
- End-stage heart failure necessitates heart transplantation, but organ availability is limited.
- Donation after circulatory death (DCD) presents an opportunity to expand the donor organ pool.
- DCD donors differ from brain-dead donors and require specific procurement protocols.
Purpose of the Study:
- To review the unique considerations and advancements in DCD heart transplantation.
- To compare outcomes of DCD heart transplants with standard donation after brain death.
- To discuss ethical aspects and logistical challenges of DCD heart procurement.
Main Methods:
- Narrative review of DCD heart transplantation literature.
- Analysis of procurement strategies including direct recovery and normothermic regional perfusion (NRP).
- Examination of evolving cold storage and ex vivo perfusion techniques.
Main Results:
- Steady improvements in post-transplant outcomes attributed to surgical and procurement advancements.
- Normothermic regional perfusion (NRP) offers a method for organ resuscitation prior to explantation.
- New developments in organ preservation enhance the viability of DCD hearts.
Conclusions:
- DCD heart transplantation is a viable strategy to increase organ availability for heart failure patients.
- Ongoing advancements in procurement and preservation are crucial for successful DCD heart transplants.
- Careful consideration of ethical and logistical factors is essential for DCD heart programs.
Abstract:
Heart transplantation is the definitive treatment for refractory, end-stage heart failure. The number of patients awaiting transplantation far exceeds available organs. In an effort to expand the donor pool, donation after circulatory death (DCD) heart transplantation has garnered renewed interest. Unlike donation after brain death, DCD donors do not meet the criteria for brain death and are dependent on life-sustaining therapies. Procurement can include a direct strategy or a normothermic regional perfusion, whereby there is restoration of perfusion to the organ before explantation. There are new developments in cold storage and ex vivo perfusion strategies. Since its inception, there has been a steady improvement in post-transplant outcomes, largely attributed to advancements in operative and procurement strategies. In this narrative review, the authors address the unique considerations of DCD heart transplantation, including withdrawal of care, the logistics of procuring and resuscitating organs, outcomes compared with standard donation after brain death, and ethical considerations.
