Characterizing Cardiac Donation After Circulatory Death: Implications for Perfusion Preservation

Ice, ice, maybe? Is it time to ditch the igloo cooler? Benefits of machine perfusion preservation of donor hearts

“…For standard criteria donors, animal heart transplantation models utilizing these devices also demonstrate similar functional recovery after implantation, as well as reduced cardiac enzyme release and cell death compared to standard criteria donors preserved by cold storage . Hypothermic machine perfusion can maintain stable oxygen consumption with low lactate accumulation in multiple human and animal models of long‐term perfusion preservation (12‐24 h of perfusion) and models of DCDD donation . Cardiac function after transplantation in these models was excellent, whereas organs preserved by hypothermic static storage in these studies typically failed .…”

“…Widespread application of machine perfusion preservation for recovery of expanded criteria and DCDD donors would basically eliminate the current donor shortage in the USA and extend transplantation as an option to more patients who are currently considered ineligible. Hypothermic machine perfusion preservation of extended and DCDD donors in preclinical and experimental models by our group and others has also demonstrated encouraging results but these devices still await clinical validation …”

“…31 Hypothermic machine perfusion can maintain stable oxygen consumption with low lactate accumulation in multiple human and animal models of long-term perfusion preservation (12-24 h of perfusion) and models of DCDD donation. [44][45][46] Cardiac function after transplantation in these models was excellent, whereas organs preserved by hypothermic static storage in these studies typically failed. 33 Edema formation during the perfusion interval has been reported with this strategy but has not resulted in adverse outcomes after reperfusion.…”

“…Hypothermic machine perfusion preservation of extended and DCDD donors in preclinical and experimental models by our group and others has also demonstrated encouraging results but these devices still await clinical validation. 44 As centers develop experience with this technology, we anticipate further advances to recondition or resuscitate organs during the perfusion interval will evolve. For example, little is known regarding myocardial substrate preferences during hypothermic machine perfusion preservation.…”

Pathophysiological aspects of heart donation from asystolic donors

“…Следует сказать, что классификация асистолических доноров была принята, в том числе, для того, чтобы хотя бы предварительно оценить степень их возможной пригодности для органного донорства [18].…”