Related Experiment Video
Updated: Jan 7, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Early and Mid-Term Results of Solid Organ Transplantation After Circulatory Death: A 4-Year Single Centre Experience
Antonella Galeone1, Marilena Casartelli Liviero2, Alex Borin3
1Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37129 Verona, Italy.
Insights
Controlled donation after circulatory death (cDCD) organ transplantation is feasible, showing excellent early and mid-term graft survival rates despite longer donor asystolic times in Italy. Further research is needed to confirm these promising outcomes.
Area of Science:
- Transplantation Medicine
- Organ Donation
- Nephrology
- Hepatology
- Cardiology
- Pulmonology
Background:
- Controlled donation after circulatory death (cDCD) has expanded the donor pool, but warm ischemia poses risks to graft function.
- Italian law mandates a 20-minute no-touch period for cDCD donors, longer than in other European countries.
- Normothermic regional perfusion (NRP) is used to mitigate ischemia-reperfusion injury in cDCD donors.
Purpose of the Study:
- To evaluate the feasibility and early/mid-term outcomes of solid organ transplantation from cDCD donors in an Italian single-center retrospective review.
- To assess 30-day graft survival and specific complications like primary non-function (PNF), non-anastomotic biliary stricture (NAS), delayed graft function (DGF), and primary graft dysfunction (PGD).
Main Methods:
- Retrospective review of cDCD procedures from April 2021 to June 2025.
- Inclusion of patients undergoing withdrawal of life-sustaining therapy (WLST) followed by a 20-minute no-touch period.
- Organ procurement and transplantation with NRP via femoral cannulation.
Main Results:
- 123 organs (46 livers, 61 kidneys, 8 hearts, 8 lungs) were transplanted into 115 recipients.
- 30-day graft survival rates: 95% (liver), 97% (kidney), 100% (heart/lung).
- Low rates of PNF (2 liver), PGD (2 lung), and DGF (3 kidney); mean recipient survival of 3.9 years.
Conclusions:
- Solid organ transplantation from cDCD donors is feasible and yields excellent early and mid-term results in Italy, even with extended donor asystolic times.
- The use of NRP appears effective in managing potential complications associated with longer ischemic periods.
- Larger studies and longer follow-up are warranted to validate these findings.
Abstract:
Background and Objectives: The use of controlled donation after circulatory death (cDCD) donors has significantly increased during the past decades and successfully expanded the donors' pool. However, warm ischemia may have detrimental effects on graft function. Italian Law requires a no-touch period of at least 20 min, which is much longer compared to the 5 min accepted in most European countries. Materials and Methods This is an Italian single-centre retrospective review of all cDCD procedures performed from April 2021 to June 2025. Patients with severe brain injury undergoing withdrawal of life-sustaining therapy (WLST) were considered for cDCD. After cardiac arrest and a no-touch period of 20 min, organ reperfusion was performed using abdominal or thoraco-abdominal normothermic regional perfusion (NRP) through femoral vessels cannulation. The primary endpoint was 30-day graft survival; secondary endpoints included: incidence of primary non-function (PNF) and non-anastomotic biliary stricture (NAS) in liver transplantation, PNF and delayed graft function (DGF) in kidney transplantation, primary graft dysfunction (PGD) in heart and lung transplantation, and recipient's survival. Results: A total of 52 patients, 33 (63%) males, median age 74 (65-79) years, underwent WLST during the study period and were included in the cDCD program. Median functional warm ischemic time (WIT), total WIT, asystolic phase, and NRP duration were 37 (34-40), 40 (37-42), 24 (23-26), and 192 (166-212) min, respectively. A total of 123 organs (46 livers, 61 kidneys, 8 hearts, and 8 lungs) were considered suitable for transplantation, procured, and successfully transplanted in 115 recipients. We report the early and mid-term outcomes of 84 recipients, including 41 liver recipients, 32 kidney recipients, and 8 heart recipients transplanted at the Azienda Ospedaliera Universitaria Integrata of Verona, and 3 lung recipients transplanted at the Azienda Ospedale Università of Padova. The 30-day graft survival was 95% in liver recipients, 97% in kidney recipients, and 100% in heart and lung recipients. PNF was observed in two liver recipients, and PGD in two lung recipients. DGF was recorded in 3 (9%) kidney recipients. Six recipients died during the follow-up, and the mean survival time was 3.9 ± 0.1 years. Conclusions: Solid organ transplantation using cDCD donors is feasible and provides excellent early and mid-term results despite longer donor asystolic times. Larger data and longer follow-up are necessary to confirm these promising results.
