The international experience of in-situ recovery of the DCD heart: a multicentre retrospective observational study

Current State of Cardiac Donation After Circulatory Death in Clinical Heart Transplantation

“…The results have been outstanding. 4 An intriguing development is that the 30-minute agonal period has been abandoned by most US teams. In a remarkable study from Spain, multiple endomyocardial biopsies were performed in hearts during a clinical DCD recovery.…”

“…Rather than delaying reperfusion, the heart and other organs are reperfused by initiation of extracorporeal life support systems in the donor. 4 Using rapid cannulation of the aorta and right atrium, either with full cardiopulmonary bypass or repurposed extracorporeal life support systems circuits, hearts can be reanimated quickly and resuscitated. These hearts can be assessed for transplant suitability and recovered in conventional ways.…”

Understanding the Brain-based Determination of Death When Organ Recovery Is Performed With DCDD In Situ Normothermic Regional Perfusion

“…The circulation reestablished may be restricted to the abdominal cavity (A-NRP) or may also include the thoracic cavity (TA-NRP). NRP reportedly improves organ utilization and recipient outcomes comparable with those of organs from DBDD donors, 4,5 but it also raises complex medical, ethical, and legal questions that must be resolved. [6][7][8] DCDD donor death determination requires the permanent absence of systemic circulation but NRP protocols reestablish systemic circulation.…”

Heart Transplantation From DCD Donors Enters the Mainstream

“…More recently, however, they and others have reported successful transplantation of DCD hearts retrieved after TANRP and then transported with static cold storage (SCS), potentially eliminating the need for machine perfusion during transport. 4,7 In centers that have adopted routine utilization of DCD hearts, survival of heart transplant recipients from DCD donors has been compared favorably with that of contemporaneous heart transplant recipients receiving grafts from donation after brain death (DBD) donors, with DCD donors now accounting for up to 40% of heart transplants performed by these centers. 4,5,7 Heart transplantation from DCD donors has now been undertaken in multiple centers across the United Kingdom, Europe, and, more recently, the United States.…”

“…4,5,7 Heart transplantation from DCD donors has now been undertaken in multiple centers across the United Kingdom, Europe, and, more recently, the United States. 7,8…”