Spanish experience with heart transplants from controlled donation after the circulatory determination of death using thoraco-abdominal normothermic regional perfusion and cold storage

Abstract

Heart transplantation from controlled donation after the circulatory determination of death (cDCDD) may help to increase the availability of hearts for transplantation. During 2020, four heart transplants were performed at three different Spanish hospitals based on the use of thoraco‐abdominal normothermic regional perfusion (TA‐NRP) followed by cold storage (CS). All donors were young adults <45 years. The functional warms ischemic time ranged from 8 to 16 minutes. In all cases, the heart recovered sinus rhythm within 1 minute of TA‐NRP. TA‐NRP was weaned off or decreased <1L within 25 minutes. No recipient required mechanical support after transplantation and all were immediately extubated and discharged home (median hospital stay: 21 days) with an excellent outcome. Four livers, eight kidneys, and two pancreata were also recovered and transplanted. All abdominal grafts recipients experienced an excellent outcome. The use of TA‐NRP makes heart transplantation feasible and allows assessing heart function before organ procurement without any negative impact on the preservation of abdominal organs. The use of TA‐NRP in cDCDD heart donors in conjunction with cold storage following retrieval can eliminate the need to use ex situ machine perfusion devices, making cDCDD heart transplantation economically possible in other countries.

Improved short-term outcomes of kidney transplants in controlled donation after the circulatory determination of death with the use of normothermic regional perfusion

“…Besides the improvement of outcomes in cDCDD kidney—and liver—transplantation, NRP makes heart transplantation from cDCDD donors possible, 37 even without the additional need for ex situ machine perfusion as made evident by some recent reports 38‐42 . NRP is also consistent with the successful recovery of lungs for transplantation, as derived from our data (almost 14% of kidneys in the NRP group were obtained from donors who also donated lungs) and as supported by some published experiences 32,43,44 …”

Expanding controlled donation after the circulatory determination of death: statement from an international collaborative

“…TA-NRP is being used in the UK, Belgium, and more recently in Spain as a strategy to allow the validation and preservation of hearts of cDCDD donors [63,[83][84][85][86]. In the British experience, most hearts recovered by using TA-NRP have been followed by ex situ machine perfusion.…”

“…In the Papworth technique, TA-NRP is followed by instrumentation on the OCS ™ -Heart device for transportation [82]. Successes with the TA-NRP technique followed by cold preservation and storage for transport have recently been reported by two teams in Belgium (Liège, Leuven) [83,84] and three centers in Spain [85,86].…”

Applying the ethical framework for donation after circulatory death to thoracic normothermic regional perfusion procedures

“…We have demonstrated that TA‐NRP DCD organ procurements meet the ethical standards of informed consent/authorization, non‐maleficence, adherence to the dead donor rule and irreversibility so they are, at minimum, ethically acceptable. If TA‐NRP DCD donation provides an opportunity for the procurement of more, and possibly, better quality donor organs, then the benefit of this type of organ donation is greater and TA‐NRP DCD has the possibility of enhancing the benefit of more lives saved from organ donation 17,18 …”