Donation After Circulatory Determination of Death in Congenital Heart Disease: Should We Embrace?
Related Experiment Video
Updated: Aug 16, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
1Department of Surgery, Division of Cardiothoracic Surgery, David Geffen School of Medicine, UCLA, Los Angeles, California.
Insights
Normothermic regional perfusion (NRP) offers a promising solution to expand the donor heart pool for pediatric heart transplantation. This method allows for in-situ assessment of donor organs, improving outcomes for children awaiting transplants.
Area of Science:
- Cardiology
- Transplantation Surgery
- Pediatric Critical Care
Background:
- Pediatric heart transplantation faces challenges due to a shortage of age and size-appropriate donors.
- Mechanical circulatory support as a bridge to transplant can have poor outcomes in younger pediatric patients.
- This donor scarcity increases morbidity and mortality in children awaiting heart transplants.
Purpose of the Study:
- To evaluate normothermic regional perfusion (NRP) as an alternative to other methods for utilizing DCDD (donation after circulatory determination of death) organs in pediatric heart transplantation.
- To address the limitations of ex-situ normothermic machine perfusion (NMP), such as cost and inability to assess organ function under load.
- To expand the donor organ pool for pediatric recipients, particularly those with congenital heart disease (CHD).
Main Methods:
- Normothermic regional perfusion (NRP) involves dynamic in-situ assessment of transplantable organs following circulatory death declaration.
- A bypass circuit establishes in-situ tissue perfusion to the donor heart, adhering to the 'dead donor rule'.
- This method allows for functional assessment of the donor organ in a loaded state prior to transplantation.
Main Results:
- The first pediatric DCDD heart transplant using NRP was successfully performed in 2019.
- Multiple centers have reported significant success using NRP for pediatric DCDD heart transplantation.
- Clinical data has not substantiated ethical concerns regarding cerebral reperfusion.
Conclusions:
- Normothermic regional perfusion (NRP) is an effective method for utilizing DCDD organs in pediatric heart transplantation.
- NRP overcomes limitations of NMP, including cost and functional assessment capabilities, and is suitable for smaller pediatric patients.
- Expanding the use of DCDD donors through NRP can significantly increase the availability of donor hearts for children with congenital heart disease.
Abstract:
The lack of donors that are age and size appropriate has compromised pediatric heart transplantation. There may be poor outcomes following mechanical circulatory support as a bridge to heart transplant in certain younger patient cohorts, which combined with the scarcity of donors, increases the morbidity and mortality in children waiting for a heart transplant. Transplantation of hearts donated after circulatory determination of death (DCDD) has been utilized to increase the pool of pediatric donor allografts. The original approach included direct procurement and perfusion in the recipient (DPP), and recently ex-situ normothermic machine perfusion (NMP). However, NMP is expensive, and this methodology does not allow for a functional assessment in a loaded state of the donor organ prior to transplantation. NMP is also not available to the smallest pediatric patients. An alternative method, normothermic regional perfusion (NRP), can overcome the limitations of NMP. NRP is a thoraco-abdominal dynamic in-situ organ assessment method and is instituted following declaration after determination of circulatory death. In-situ tissue perfusion is established to the transplantable organs using a bypass circuit based on strict, prespecified guidelines that do not violate the "dead donor rule." The first pediatric DCDD heart transplant using NRP was performed in 2019, and since then, several centers have reported immense success. Ethical concerns for cerebral reperfusion have not been substantiated by clinical data. Utilization of DCDD donors can vastly expand the donor pool in congenital heart disease (CHD).
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