The role of transesophageal echocardiography in guiding heart donation after circulatory death

Abstract

Heart donation after circulatory death (DCD) can significantly expand the heart donor pool, helping to overcome the problem of organ shortage and the increase in waiting list mortality and morbidity. To improve the outcome of DCD heart transplantation, thoraco-abdominal normothermic regional perfusion (TA-NRP) can be performed by selectively restoring circulation followed by in vivo functional heart assessment. Here, we report on the use of periprocedural transoesophageal echocardiography (TOE) as a minimally invasive cardiac assessment tool during different stages of a DCD heart procurement procedure using TA-NRP. We conclude that TOE is a valuable method to assess the donor heart for transplantation eligibility before and after withdrawal of life-sustaining therapy and during subsequent TA-NRP.

Metabolic Considerations in Direct Procurement and Perfusion Protocols with DCD Heart Transplantation

“…The Belgian protocol, for example, marks one exception, where antemortem interventions are not prohibited by law as long as they do not directly cause the patient harm or discomfort. This allows for antemortem heparin administration and insertion of a guidewire or cannula [14]. As such, clinically relevant techniques to optimize cardiac tolerance to warm ischemia, such as protective reperfusion strategies, must be identified; approaches that are best adapted for cardiac preservation during graft storage must be developed for previously ischemic hearts, and reliable means to assess the viability of DCD grafts need to be established [4].…”

Expanding the Criteria for Heart Transplantation Donors: A Review of DCD, Increased Ischemic Times, HCV, HIV, and Extended Criteria Donors

“…Literature describing the logistics of implementation is also increasing, reflecting increased openness and standardization to TA-NRP [32][33][34]. These procedural descriptions include instructions for anesthesia, echocardiography, and heart function measurement, providing a guide for centers interested in incorporating NRP into their procurements [35,54,55]. With concerns about TA-NRP in DCD HT being addressed and accessibility increasing with standardized procedures, utilization of DCD HT with TA-NRP provides a promising means of increasing the donor pool for HT.…”

Successful heart transplantation from donation after euthanasia with distant procurement using normothermic regional perfusion and cold storage

“…[Color figure can be viewed at wileyonlinelibrary.com] femoral arterial line was inserted to allow measurement of the arterial pressure. Given the rapid and spontaneous reversion to SR, in addition to the excellent contractility of both ventricles observed on the transoesophageal echocardiography images, 6 no inotrope infusion was required. After 42 min of TA-NRP, contractility sufficiently recovered to solely support regional perfusion of the thorax and the abdomen.…”