Heart transplantation from donation after circulatory determined death

Abstract

Fifty years since the first successful human heart transplant from a non-heart beating donor, this concept of heart transplantation from donation after circulatory determined death (DCD) promises to be one of the most exciting developments in heart transplantation. Heart transplantation has established itself as the best therapeutic option for patients with end-stage heart failure, with the opportunity to provide these patients with a near-normal quality of life. However, this treatment is severely limited by the availability of suitable donor hearts. In recent times, heart transplantation has been limited to using donor hearts from donors following brain stem death. The use of donor hearts from DCD had been thought to be associated with high risk and poor outcomes until recent developments in organ perfusion and retrieval techniques have shown that this valuable resource may provide an answer to the global shortage of suitable donor hearts. With established DCD heart transplant programmes reporting encouraging results, this technique has been shown to be comparable to the current gold standard of donation after brain death (DBD) heart transplantation.

Heart transplantation from cardiac arrest-resuscitated donors

“…Использование сердец от доноров, перенесших СЛР, является одним из подходов к расширению критериев сердечного донорства [13]. Внедрение технологии контролированного асистолического донорства с или без последующей ex vivo перфузии изъятого сердца показывает возможность успешного восстановления насосной функции сердечного трансплантата, перенесшего разную по продолжительности тепловую ишемию до начала фармакохолодовой консервации [15][16][17].…”

HEART TRANSPLANTATION FROM DONORS WITH LEFT VENTRICULAR EJECTION FRACTION <40%

“…В последнее время проявляют интерес к ТС от доноров со сниженной (менее 40-50%) ФИ ЛЖ как европейские, так и американские трансплантационные центры, что обусловлено катастрофическим дефицитом сердечных доноров со стандартными критериями и высокой потребностью в пересадке сердца [24]. Выполнение не только в эксперименте, но и в клинике первых ТС от асистолических доноров также поддерживает научно-практический интерес к возможности восстановления сердец, перенесших тяжелое ишемически-реперфузионное повреждение в условиях экстракорпоральной нормотермической перфузии [25].…”

Ethical Decision Diagrams on Donation After Cardiocirculatory Death Heart Transplantation Considering Organ Preservation Techniques

“…Three major techniques are applied for preserving the DCD-heart during transportation: (1) direct procurement and perfusion (DPP); (2) normothermic regional perfusion (NRP) followed by cold static storage (CSS); and (3) NRP followed by ex vivo machine perfusion (EVMP). 1 A fourth option, which is rarely practiced, is direct procurement (DP) followed by CSS. In DPP, the heart of the deceased donor is explanted and resuscitated in the EVMP device with warm donor blood.…”

“…However, the quantity of HTx is limited by the organ shortage. 1 To overcome this major problem, some centers have extended their acceptance criteria for organ donors from classical brain-dead donors to marginal donors. Within this population, in some countries organs from nonheart beating donors are accepted for donation after cardiocirculatory–determined death (DCD).…”