Related Experiment Video
Updated: Aug 14, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Reperfusion Strategies in Donation After Circulatory Death Heart Transplantation: An Up-to-Date Narrative Review
Antonella Galeone1, Giovanni Battista Luciani1, Francesco Onorati2
1Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy.
Insights
Donation after circulatory death (DCD) increases organ donors. However, heart preservation after DCD faces challenges from warm ischemia and reperfusion injury, with varied strategies lacking comparative trials.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Donation after circulatory death (DCD) is a vital strategy to expand the donor pool globally.
- The heart is highly susceptible to warm ischemia and reperfusion injury following DCD, impacting graft viability.
- Current reperfusion strategies show promise but face financial, logistical, and ethical hurdles, leading to inconsistent protocols.
Purpose of the Study:
- To review current reperfusion strategies for hearts from DCD donors.
- To highlight the challenges and heterogeneity in DCD heart preservation protocols.
- To identify the need for comparative studies on DCD heart reperfusion techniques.
Main Methods:
- Review of existing literature on DCD heart reperfusion strategies.
- Analysis of clinical evidence from retrospective and observational studies.
- Examination of financial, logistical, and ethical considerations for different techniques.
Main Results:
- Multiple reperfusion strategies exist, demonstrating promising short- and long-term outcomes for DCD heart grafts.
- Significant heterogeneity in protocols exists globally due to varied challenges.
- No randomized clinical trials have directly compared the efficacy of different reperfusion techniques.
Conclusions:
- Reperfusion strategies are crucial for optimizing outcomes in DCD heart transplantation.
- Standardization of protocols is needed to address the current heterogeneity.
- Further high-quality research, particularly randomized clinical trials, is essential to determine the optimal reperfusion strategy for DCD hearts.
Abstract:
Donation after circulatory death has emerged worldwide as a safe and effective alternative pathway to increase the donor pool. However, organs undergo a variable period of warm ischemia during the agonal phase and the cardiac arrest before graft procurement, and the heart is particularly vulnerable to injury provoked by warm ischemia and subsequent reperfusion. Several reperfusion strategies are currently available for the recovery and assessment of heart function in these donors, with promising early and long-term results. Nevertheless, each technique implies specific financial, logistical and ethical challenges, translating into a heterogeneous landscape of protocols across European and non-European countries. Additionally, no randomized clinical trials have been published to assess the superiority of one technique over the other, and current clinical evidence is based on retrospective registry data and single-center observational studies.
