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Updated: Jun 9, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Surgical technique of donation after circulatory death heart procurement using direct procurement and hypothermic
K Vandendriessche1, J Brouckaert1, K Van de Voorde1
1Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
Insights
Direct procurement of hearts from donation after circulatory death (DCD) using hypothermic oxygenated perfusion (HOPE) offers a simplified preservation method. This approach expands the donor heart pool with favorable early outcomes when strict criteria are met.
Area of Science:
- Cardiology
- Transplantation Surgery
- Organ Preservation
Background:
- Donation after circulatory death (DCD) is increasingly utilized to expand the donor heart pool.
- Current methods include normothermic machine perfusion or thoraco-abdominal normothermic regional perfusion.
- This study explores an alternative preservation strategy for DCD hearts.
Purpose of the Study:
- To detail the practical aspects of direct procurement of DCD hearts followed by hypothermic oxygenated perfusion (HOPE).
- To present an alternative to existing DCD heart preservation techniques.
Main Methods:
- Direct procurement of DCD hearts.
- Preservation using hypothermic oxygenated perfusion (HOPE).
- Key considerations include preventing bubble formation and early machine priming to minimize ischemic time.
Main Results:
- Graft acceptance criteria include warm ischemic time <30 minutes, satisfactory cardioplegic flush and anatomy, and stable machine perfusion.
- While functional assessment is not possible, early results indicate favorable outcomes with strict donor and procedural criteria.
- This method avoids donor blood recirculation.
Conclusions:
- Direct procurement of DCD hearts with HOPE is a simplified and logistically efficient preservation method.
- Favorable outcomes are observed when strict donor and procedural criteria are followed.
- Further research is needed to refine candidate selection and evaluate long-term results.
Introduction:
Donation after circulatory death (DCD) has re-emerged as a means of expanding the donor heart pool. Current clinical practice relies mainly on direct procurement followed by normothermic machine perfusion or on thoraco-abdominal normothermic regional perfusion. This paper details the practical aspects with an alternative strategy: direct procurement followed by hypothermic oxygenated perfusion (HOPE).
Methods:
Key technical considerations include prevention of bubble formation in albumin-containing solutions and early machine priming to avoid ischemic delays. The final acceptance of grafts is based on a functional warm ischemic time <30 min, satisfactory cardioplegic flush and anatomy, and stable, uneventful machine perfusion.
Conclusion:
Though this approach does not permit functional assessment of the graft, early results suggest that when strict donor and procedural criteria are observed, outcomes are favorable. Direct procurement of the DCD heart with HOPE offers a simplified, logistically efficient preservation method that avoids donor blood recirculation. Further studies are warranted to refine candidate selection and assess long-term results.
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