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Updated: Jun 16, 2025
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Donation After Circulatory Death Cardiac Recovery Technique: Single-Center Observational Outcomes
Chetan Pasrija1, Alexandra DeBose-Scarlett1, Hasan K Siddiqi2
1Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Normothermic regional perfusion (NRP) and direct procurement and perfusion (DPP) offer comparable early outcomes for heart transplants from circulatory death donors. Further research is needed to confirm these findings in larger studies.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Innovation
Background:
- Donation after circulatory death (DCD) heart recovery utilizes direct procurement and perfusion (DPP) or normothermic regional perfusion (NRP).
- Optimal post-transplant outcomes between DPP and NRP strategies remain unclear.
Purpose of the Study:
- To compare the efficacy of NRP and DPP in heart allograft recovery.
- To evaluate post-transplant outcomes associated with each recovery strategy.
Main Methods:
- Retrospective review of heart transplant recipients from DCD donors (February 2020-January 2023).
- Stratification into NRP and DPP cohorts, with DPP utilizing the TransMedics Organ Care System.
- Primary outcome: severe primary graft dysfunction at 24 hours, defined by need for extracorporeal membrane oxygenation.
Main Results:
- 118 hearts transplanted (NRP: 87, DPP: 31).
- No significant difference in severe primary graft dysfunction at 24 hours (NRP 5.8% vs. DPP 12.9%).
- Higher ejection fraction at 7 days post-transplant in the NRP group (65% vs. 60%).
Conclusions:
- NRP and DPP strategies yield comparable early allograft outcomes.
- No significant differences in 30-day or 1-year survival between groups.
- Larger prospective studies are warranted to validate these findings.
Background:
Recovery of hearts from donation after circulatory death donors has been performed either with direct procurement and perfusion (DPP) using the TransMedics Organ Care System or with normothermic regional perfusion (NRP) with subsequent cold storage. It remains unclear which of these 2 strategies yields optimal posttransplant outcomes.
Methods:
All heart transplant recipients from donors after circulatory death donors at the Vanderbilt University Medical Center (Nashville, TN) were reviewed (February 2020 to January 2023). Recipients were stratified into an NRP or DPP cohort. All DPP recoveries were performed using the TransMedics Organ Care System. The key outcome was severe primary graft dysfunction at 24 hours, defined by the need for postoperative extracorporeal membrane oxygenation.
Results:
A total of 118 hearts were transplanted (NRP, 87; DPP, 31). Donors recovered using NRP were younger (25 years [interquartile range {IQR}, 21-31 years] vs 31 years [IQR, 24-37 years]; P = .008) and had shorter distance traveled (292 miles [158-516 miles] vs 449 miles [IQR, 248-635 miles]; P = .02). Recipient preoperative risk factors were similar between the groups. There was no difference in the incidence of severe primary graft dysfunction at 24 hours (NRP, 5.8%; and DPP, 12.9%; P = .24). However, ejection fraction at 7 days after transplantation was higher in the NRP group (65% [IQR, 60%-65%] vs 60% [IQR, 60%-68%]; P = .005). There was no difference in inotrope scores at 24 hours (P = 1.00) or 72 hours (P = .87) or in 30-day (NRP, 95% vs DPP, 97%; P = .75) and 1-year (NRP, 94% vs DPP, 86%; P = .19) survival.
Conclusions:
NRP and DPP strategies for recovery of cardiac allografts yield comparable early allograft outcomes. Future studies are needed to confirm these findings in larger prospective cohorts.
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