Related Experiment Video
Updated: Jun 13, 2025
Author Spotlight: Enhancing Donor Heart Preservation Through Isolated Rat Heart Perfusion Studies
Published on: October 4, 2024
Alternative preservation strategies of DCD hearts: Effect of cold ischemia time before normothermic machine perfusion
Insights
Controlled hypothermia offers a viable alternative for preserving hearts from donation after circulatory death (DCD) donors. This method shows no functional differences compared to immediate reperfusion, potentially improving donor heart transplantation.
Area of Science:
- Cardiovascular Surgery
- Organ Transplantation
- Preservation Medicine
Background:
- Donation after circulatory death (DCD) heart transplantation expands donor pools but faces challenges with warm ischemia injury.
- Current DCD heart assessment methods like thoracoabdominal normothermic regional perfusion (taNRP) and direct procurement and reperfusion (DPP) have ethical or logistical limitations.
Purpose of the Study:
- To explore controlled hypothermia as an alternative preservation strategy for DCD heart grafts.
- To evaluate the viability and function of DCD hearts preserved using controlled hypothermia followed by normothermic machine perfusion.
Main Methods:
- Porcine DCD hearts underwent 19 minutes of warm ischemia, followed by up to 7 hours of controlled cold static preservation (6-8°C).
- Graft viability was assessed using ex vivo cardiac loading, biochemical, and proteomic analyses.
- Compared preservation outcomes with immediate reperfusion controls.
Main Results:
- No significant functional, biochemical, or proteomic differences were found between DCD hearts preserved with controlled hypothermia and those reperfused immediately.
- Controlled hypothermia preservation for up to 7 hours maintained DCD heart graft viability.
Conclusions:
- Controlled hypothermia presents a promising, cost-effective alternative to current DCD heart preservation techniques.
- This approach may reduce logistical complexity and ethical concerns, potentially increasing the utilization of DCD donor hearts.
Abstract:
Donation after circulatory death (DCD) offers a promising strategy to expand the donor pool by 20-30%. However, DCD heart grafts suffer from warm ischemia injury, making effective graft viability assessment before transplantation prudent. Current methods for assessing DCD hearts are impacted either by ethical concerns and regional limitations (thoracoabdominal normothermic regional perfusion - taNRP) or by the need for significant resources, expertise, and equipment, with limitations in functional assessment (direct procurement and reperfusion - DPP, via the Organ Care System (OCS) by TransMedics). This study explores an alternative approach to DCD heart preservation, using controlled hypothermia at 6-8 degrees Celsius for up to 7 hours, followed by reanimation using normothermic machine perfusion. DCD grafts were procured from porcine donors after 19 mins of functional warm ischemia, stored via controlled cold static preservation for up to 7 hours and evaluated via a novel method of ex vivo cardiac loading. No functional, biochemical or proteomic differences were observed between DCD cardiac grafts stored via controlled hypothermia for up to 7 hours and DCD grafts reperfused immediately after procurement. These results suggest that controlled hypothermia may be a viable alternative to current DCD preservation methods, eliminating ethical concerns of taNRP and reducing logistical complexity and costs associated with DPP. These findings provide a foundation for a potential shift in DCD heart preservation practices, offering a more effective and cost-efficient approach to expand the donor pool and improve transplantation outcomes.
