Outcomes of Donation After Circulatory Death Heart Transplantation in Australia

Chew, Hong Chee; Iyer, Arjun; Connellan, M.; Scheuer, Sarah; Villanueva, Jeanette; Gao, Ling; Hicks, Mark; Harkness, M.; Soto, Claudio; Dinale, Andrew; Nair, Priya; Watson, Ash; Granger, Emily; Jansz, P.; Muthiah, K.; Jabbour, Andrew; Kotlyar, Eugene; Keogh, Anne; Hayward, Chris; Graham, Robert M.; Spratt, Phillip; Macdonald, P.; Dhital, K.

doi:10.1016/j.jacc.2018.12.067

Cited by 195 publications

(204 citation statements)

References 24 publications

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“…While the reported short and intermediate outcomes with DCD hearts are comparable to DBD heart transplantations, it is critical that a close follow‐up is performed to track the long‐term outcomes. At present, the concerns due to primary graft dysfunction and data from animal experiments have limited the DCD WIT to less than 30 minutes 12,25,29 . With an appropriate resuscitative platform, this time may be extended to over 30 minutes.…”

Section: Remaining Challenges To Expand Dcd Heart Transplantationmentioning

confidence: 99%

“…34 Similarly, it is apparent that over 40% of DCD heart transplant recipients had severe primary graft dysfunction, as defined by the International Society for Heart and Lung Transplantation, requiring ECMO support. 25,28,29 Severe primary graft dysfunction is a serious condition with less than 15% prevalence and over 30% mortality, as studied in DBD heart transplantation. 35 While the numbers of patients requiring ECMO support following DCD heart transplantation are alarmingly high, given the good short-term outcomes, it is possible to postulate that the transplantation teams had lower threshold to support the DCD hearts on ECMO.…”

Section: Predicted Contributions Of Dcd Hearts For Transplantationmentioning

confidence: 99%

“…At present, the concerns due to primary graft dysfunction and data from animal experiments have limited the DCD WIT to less than 30 minutes. 12,25,29 With an appropriate resuscitative platform, this time may be extended to over 30 minutes.…”

Section: Predicted Contributions Of Dcd Hearts For Transplantationmentioning

confidence: 99%

“…24 Placing a heart on the OCS requires some technical expertise and some potentially transplantable hearts were lost due to technical challenges. 29 More importantly, TransMedics OCS is expensive (each heart perfused costed 30 000.00 euros, excluding the supplies) and not within the reach of many transplantation centers. 11 Its large size also requires modifications during transportation.…”

Section: Ex Situ Perfusion Preservationmentioning

confidence: 99%

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Heart transplantation from donation after circulatory death donors: Present and future

et al. 2020

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The first successful human heart transplantation was reported on 3 December 1967, by Christiaan Barnard in South Africa. Since then this life‐saving procedure has been performed in over 120 000 patients. A limitation to the performance of this procedure is the availability of donor hearts with as many as 20% of patients dying before a donor's heart is available for transplant. Today, hearts for transplantation are procured from individuals experiencing donation after brain death (DBD). Interestingly, this, however, was not always the case as the first heart transplants occurred after circulatory death. Revisiting the availability of hearts for transplant from those experiencing donation after circulatory death (DCD) could further expand the number of hearts suitable for transplantation. There are several considerations pertinent to transplanting hearts from those undergoing circulatory death. In this review, we summarize the main distinctions between DBD and DCD heart donation and discuss the research relevant to increasing the number of hearts available for transplantation by including individual's hearts that experience circulatory death.

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Section: Remaining Challenges To Expand Dcd Heart Transplantationmentioning

confidence: 99%

Section: Predicted Contributions Of Dcd Hearts For Transplantationmentioning

confidence: 99%

Section: Predicted Contributions Of Dcd Hearts For Transplantationmentioning

confidence: 99%

Section: Ex Situ Perfusion Preservationmentioning

confidence: 99%

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Heart transplantation from donation after circulatory death donors: Present and future

et al. 2020

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“…Due to a universal shortage of donor allografts, there has been renewed interest in DCD heart transplantation, which is not currently performed in the United States. [3][4][5] Recently, in the Journal of the American College of Cardiology, Chew and colleagues 6 report on their series of 23 cardiac transplants using DCD donors at St Vincent's Hospital in Sydney, Australia. The authors provide a detailed description of their clinical protocol and intermediate results.…”

mentioning

confidence: 99%

Is it time for the United States to engage in heart transplantation using donation after circulatory death?

Jawitz

Milano

2020

The Journal of Thoracic and Cardiovascular Surgery

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Feature Editor's Note-Despite significant advances in medical management and availability of durable mechanical circulatory support devices to treat end-stage heart disease, no therapy to date has provided the survival benefit afforded by heart transplantation. For an adult patient who received a heart transplant worldwide between 2002 and 2008, median survival following heart transplantation now extends to 12.2 years (Lund LH. J Heart Lung Transplant. 2017;36:1037-46). Despite the significant increase in the number of heart transplant procedures performed in the United States over the past 10 years as a result of the expansion of acceptable donor criteria and the opioid epidemic (Durand CM. Ann Intern Med. 2018;168:702-11), heart transplantation has been chronically plagued by donor shortages that have limited the overall epidemiologic benefit of this therapy. Recently, there has been a growing interest in using heart organs obtained from donors following circulatory death (ie, donation after circulatory death [DCD]) to expand the heart donor pool (see the recent report by Chew and colleagues. J Am Coll Cardiol. 2019;73:1447-59). In this issue of the Journal, Jawitz and Milano provide a timely and thoughtful review of the state of DCD heart transplantation and the report by Chew and colleagues. Jawitz and Milano review recent compelling evidence from Australia and the United Kingdom on DCD heart transplantation and present a very cogent argument why such a strategy should be implemented in the United States. Despite a robust experience with DCD transplantation of lungs, livers, and kidneys in the United States, DCD heart transplantation carries inherent clinical challenges, including ensuring equivalent clinical outcomes to brain-death donors, ethical issues in management of the donor, and increase in resource use to sustain a DCD heart-transplant program. As put forth by Kawitz and Milano, a significant ethical and clinical framework for DCD heart donation in the United States has been made by groundbreaking efforts in Australia and the United Kingdom. Because of the dire need for donor hearts, it is clinically necessary to resolve these controversies and challenges to expand the current heart donor pool in the United States.

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Cardiac Donor Evaluation

Milano,

Chiang

2023

Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease

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Outcomes of Donation After Circulatory Death Heart Transplantation in Australia

Cited by 195 publications

References 24 publications

Heart transplantation from donation after circulatory death donors: Present and future

Heart transplantation from donation after circulatory death donors: Present and future

Is it time for the United States to engage in heart transplantation using donation after circulatory death?

Cardiac Donor Evaluation

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