Related Experiment Video
Updated: Jan 23, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Direct procurement and ex-situ assessment of donor hearts after controlled circulatory death: A French national pilot
Ali Akamkam1, Maïra Gaillard2, Simon Dang Van3
1Department of Adult Cardiac Surgery and Transplantation, Marie-Lannelongue Hospital, groupe hospitalier Paris Saint-Joseph, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France; Laboratory of Preclinical Research, Department of Research and Innovation, groupe hospitalier Paris Saint-Joseph, 92350 Le Plessis-Robinson, France; Inserm, UMR_S 999, hypertension pulmonaire: physiopathologie and innovation thérapeutique (HPPIT), ERN-LUNG, hôpital Bicêtre, AP-HP, hôpital Marie-Lannelongue (groupe hospitalier Paris Saint-Joseph), université Paris-Saclay, 92350 Le Plessis-Robinson, France.
Insights
Donation after controlled circulatory death (DCD) heart procurement is feasible in France, enabling transplantation. Metabolic analysis revealed nucleotide catabolism and carnitine consumption, indicating heart suitability for transplant.
Area of Science:
- Cardiology and Transplant Surgery
- Organ Procurement and Preservation
- Metabolomics and Biomedical Research
Background:
- Heart transplantation from donation after controlled circulatory death (DCD) is currently not authorized in France.
- A feasibility study was therefore mandated to explore DCD heart procurement protocols.
Purpose of the Study:
- To validate the feasibility of DCD heart procurement through a preclinical study.
- To investigate the metabolic signature of DCD hearts during normothermic ex-situ perfusion (NESP).
Main Methods:
- Abdominal normothermic regional perfusion (A-NRP) was established via femoral cannulation for DCD donors.
- Hearts underwent direct procurement followed by 4 hours of NESP, with lactate monitoring.
- Plasma and left ventricular biopsies were collected for untargeted metabolomic analysis using LC-MS.
Main Results:
- All five DCD hearts were successfully perfused for 4 hours, with decreasing lactate levels.
- Metabolomic analysis of plasma showed significant changes in 166 metabolites, including increases in purines and amino acids.
- Biopsy samples revealed changes in 103 metabolites, with decreases in carnitines and nucleotides.
Conclusions:
- DCD heart procurement is demonstrated as feasible in the French context.
- Lactate trends and metabolic profiles suggest DCD hearts are suitable for transplantation.
- The metabolic signature indicates nucleotide catabolism and carnitine utilization during perfusion.
Background:
Heart transplantation following donation after controlled circulatory death (DCD) is not authorized in France, hence a feasibility study was mandatory.
Aims:
To conduct a preclinical study to validate the feasibility of DCD heart procurement. We further sought to investigate the metabolic signature of DCD hearts during normothermic ex-situ perfusion (NESP).
Methods:
The study design was approved by the Agence de la biomedecine (PFS20-004, La Plaine Saint-Denis, France). Five patients were considered for DCD heart procurement. Femoral vessels were canulated to ensure abdominal normothermic regional perfusion (A-NRP). Direct procurement followed by 4hours of NESP was performed. Donors' demographics and duration of functional warm ischaemic time (fWIT) were collected. Lactate levels were assessed every 30minutes during NESP. Plasma and left ventricular biopsies were collected every 30 and 60minutes, respectively, for untargeted metabolomic analyses using liquid chromatography coupled to high-resolution mass spectrometry.
Results:
Mean±standard deviation donor age was 40±11 years and fWIT for the hearts was 26±10min. DCD lungs and kidneys were transplanted except in one case each (impaired ex vivo lung perfusion and premature arrest of A-NRP, respectively). DCD livers were all transplanted when allocated. All hearts were successfully perfused for 4hours. Lactate decreased during NESP for all hearts with a mean±standard deviation initial lactate at 5.42±0.98mmol/L and a final concentration at 3.02±0.86mmol/L (P=0.003). In plasma samples, there were notable changes for 166 metabolites. Most of them either initially increased and stabilized (64/166; 38.6%, e.g. carnitines) or continuously increased (67/166; 40.4%, e.g. purines, medium-chain fatty acids and amino acids). In biopsy samples, there were notable changes for 103 metabolites. Most of them initially decreased and stabilized, such as carnitines and nucleotides.
Conclusion:
DCD heart procurement is feasible in France. Lactate trends were consistent with suitability of these hearts for transplantation. The metabolomic signature was characterized by nucleotide catabolism along with consumption of carnitines.
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