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Updated: Sep 9, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Ex-Vivo Heart Perfusion Machines in DCD Heart Transplantation Model: The State of Art
Chiara Tessari1, Giovanni Lucertini1, Mariangela Addonizio1
1Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, University of Padua, Padova, Italy.
Insights
Ex-vivo machine perfusion (EVMP) aids Donation-after-Circulatory-Death (DCD) heart transplantation by improving graft quality and outcomes. EVMP is a valid tool for organ preservation and transport, reducing primary graft dysfunction.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Preservation
Background:
- Donation-after-Circulatory-Death (DCD) heart transplantation expands the donor pool but increases risks of ischemic-related myocardial injury (IRI) and primary graft dysfunction (PGD).
- Ex-vivo machine perfusion (EVMP) is emerging as a strategy to mitigate these risks and improve graft assessment.
Purpose of the Study:
- To review the clinical role, outcomes, and future perspectives of EVMP in DCD heart transplantation.
- To analyze the impact of EVMP on graft quality and patient survival.
Main Methods:
- A comprehensive review of preclinical and clinical studies on EVMP in DCD heart donation.
- Analysis of 21 clinical studies utilizing the Organ-Care-System (TransMedics) for machine perfusion.
Main Results:
- Preclinical studies initially focused on graft function evaluation, with recent research exploring associated therapies.
- Clinical outcomes, including survival rates and rejection episodes, using EVMP in DCD heart transplantation are comparable to donation-after-brain-death.
- EVMP demonstrates efficacy in organ preservation and transport for DCD hearts.
Conclusions:
- EVMP is a valuable tool for DCD heart transplantation, enhancing organ preservation and transport.
- Further preclinical research is essential for reducing IRI, enabling organ reconditioning, and minimizing PGD incidence.
- EVMP offers comparable outcomes to traditional methods, supporting its role in expanding transplantation options.
Abstract:
The Donation-after-Circulatory-Death (DCD) heart transplantation program increases donor pool but resulting in more serious ischemic-related myocardial injury (IRI), leading to higher incidence of primary graft dysfunction (PGD). Ex-vivo machine perfusion (EVMP) for DCD heart is being considered a useful aid in improving grafts number and quality assessment, aiming to better outcomes. In this review we will analyze the role of EVMP techniques in the context of DCD with special attention to their clinical aims and results and future perspectives. A review of available clinical and pre-clinical studies involving EVMP with DCD donation model was performed. Thirty-four original articles about preclinical studies were found. First studies were designed to evaluate graft function in DCD hearts after EVMP, while recent research focus on possible therapies that could be associated with EVMP. Twenty-one original articles about clinical studies were found with the Organ-Care-System (TransMedics) as MP used. Outcomes, such as survival rates or rejection episodes, are comparable to outcomes from donation-after-brain-death. EVMP in the setting of DCD heart transplantation can be a valid tool for organ preservation and transport. The role of pre-clinical research will be crucial to reduce IRI, achieve organ reconditioning and reduce incidence of PGD.
