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Updated: May 7, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Outcomes After Donation After Circulatory Determination of Death Cardiac Transplantation: An International,
John O Louca1, Marco Öchsner2, Sai Bhagra3
1University of Cambridge, Cambridge Stem Cell Institute, Cambridge, United Kingdom; Royal Papworth Hospital, Cambridge, United Kingdom; University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom.
Insights
Thoraco-abdominal normothermic regional perfusion (taNRP) for donor heart recovery in donation after circulatory determination of death (DCD) heart transplantation (HT) led to better outcomes. Recipients of taNRP-retrieved hearts showed reduced severe primary graft dysfunction and acute cellular rejection compared to direct procurement and perfusion (DPP).
Area of Science:
- Cardiology
- Transplantation Surgery
- Organ Procurement
Background:
- Donation after circulatory determination of death (DCD) heart transplantation (HT) is increasingly common.
- Effective organ procurement methods are crucial for DCD HT success.
- Comparing retrieval techniques is essential for optimizing clinical outcomes.
Purpose of the Study:
- To compare outcomes of DCD HT using two donor heart retrieval methods: thoraco-abdominal normothermic regional perfusion (taNRP) versus direct procurement and perfusion (DPP).
- To evaluate the impact of retrieval technique on post-transplant survival, primary graft dysfunction, and acute cellular rejection.
Main Methods:
- Retrospective observational study across 22 international heart transplant centers (Europe and US).
- Included DCD HT recipients from program inception to January 1, 2023.
- Compared outcomes between taNRP and DPP retrieval groups, focusing on 1-year survival, severe primary graft dysfunction (PGD), and treated acute cellular rejection (ACR).
Main Results:
- A total of 504 DCD HTs were analyzed.
- One-year survival was similar between taNRP (91%) and DPP (88%) groups (P = 0.100).
- taNRP recipients experienced significantly lower rates of severe PGD (7.6% vs 19.2%; P < 0.001) and treated ACR (13% vs 25%; P < 0.001).
Conclusions:
- Donor heart retrieval using taNRP is associated with reduced severe PGD and acute cellular rejection in DCD HT compared to DPP.
- taNRP may represent a more effective organ procurement strategy for DCD heart transplantation.
- Further investigation with randomized controlled trials is warranted to confirm these findings.
Background:
As donation after circulatory determination of death (DCD) heart transplantation (HT) becomes more widely adopted, there is a need to establish the most clinically effective method of organ procurement.
Objectives:
This international, multicenter study compares outcomes of DCD HT across Europe and the United States between recipients whose donor hearts were retrieved using thoraco-abdominal normothermic regional perfusion (taNRP) with those whose hearts were recovered using direct procurement and perfusion (DPP).
Methods:
This was a retrospective observational study across 22 heart transplant centers in Belgium, Spain, the United Kingdom, and the United States. This study included all patients undergoing DCD HT at participating centers, from the start of each center's DCD program through January 1, 2023. DCD HT with recovery using either taNRP or DPP were compared with one another. Posttransplant outcomes included: 1) survival at 1 year; 2) incidence of severe primary graft dysfunction (PGD); and 3) episodes of treated, biopsy-proven acute-cellular rejection (ACR) in the first year following transplantation.
Results:
A total of 504 DCD HTs took place in the study period. Survival at 1 year was similar for taNRP and DPP recipients (91% vs 88%; P = 0.100). taNRP recipients had a lower rate of severe PGD (7.6% vs 19.2%; P < 0.001) and fewer episodes of biopsy-proven, ACR requiring treatment in the first year post-transplantation (13% vs 25%; P < 0.001).
Conclusions:
In an international study of DCD HT, recipients of hearts retrieved by taNRP technique had lower rates of severe PGD and fewer episodes of biopsy-proven ACR in the first year when compared with those retrieved by using DPP. These results should be further investigated with randomized control trials.
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