Normothermic donor heart perfusion: current clinical experience and the future

Abstract

Following the first successful heart transplant in 1967, more than 100 000 heart transplants have been carried out worldwide. These procedures have mostly relied on cold ischaemic preservation of the donor heart because this simple technique is inexpensive and relatively reliable. However, the well-known limitations of cold ischaemic preservation imposes significant logistical challenges to heart transplantation which put a ceiling on the immediate success on this life-saving therapy, and limits the number of donor hearts that can be safely transplanted annually. Although the theoretical advantages of normothermic donor heart perfusion have been recognised for over a century, the technology to transport donor hearts in this state has only been developed within the last decade. The Organ Care System (OCS) which is designed and manufactured by TransMedics Inc. is currently the only commercially available device with this capability. This article reviews the history of normothermic heart perfusion and the clinical experience with the TransMedics OCS to date. We have also attempted to speculate on the future possibilities of this innovative and exciting technology.

Donor selection in the modern era

“…In the United Kingdom, DCD donors represent an even greater proportion of the organ donor pool, and DCD donation could increase heart transplant rates by over 30% (55). Cardiac transplantation with distantly procured DCD hearts has only recently been undertaken, after much groundwork was performed to develop ways to minimize cardiac damage during withdrawal of life support (56,57), to optimize organ preservation during transport via use of ex vivo normothermic perfusion (58) and to assess cardiac function prior to transplantation (59). The heart transplant programs at St. Vincent's Hospital (Sydney, Australia), Papworth Hospital (Cambridge, UK) and Harefield Hospital (London, UK) have pioneered the use of DCD donor hearts for transplantation, with excellent clinical outcomes.…”

Heart transplantation from donation after circulatory determined death

“…Although DCD heart transplantation has relied heavily on ex-situ organ perfusion where normothermia was the preferred strategy (27), there are a number of heart perfusion devices currently being developed which may offer an alternative strategy to preservation of the DCD heart (28).…”

Transplante Cardíaco E Tecnologias De Acondicionamento De Órgãos Por Perfusão

“…A avaliação prévia do órgão a ser transplantado, o prolongamento do tempo fora do corpo do doador, mantendo preservado os tecidos e a possibilidade de transporte a longas distâncias, são benefícios proporcionados com o uso dessas tecnologias [7].…”

“…Composto de um compartimento onde é posicionado o coração do doador, canulado pela aorta e troco pulmonar, sendo perfundido por sangue, uma bomba diafragmática para gera o fluxo, a temperatura é fornecida por uma placa integrada. É acompanhado nos painéis os batimentos, frequências, fluxo, temperatura e oxigenação [7].…”