“However, over the last few years transplant centers have developed various protocols for organ procurements from DCD donors that help to overcome this,” he said. Concerns about ischemic injury, including the inability to assess the extent of damage, have historically prohibited the use of DCD hearts, Madan explained. In the setting of DCD, however, the donor heart is exposed to a degree of “warm ischemic injury” that results from inadequate oxygenation after circulatory arrest or perfusion after the withdrawal of life support.
One strategy proposed to counter the shortage of organs is to use hearts from donors pronounced dead after the heart has irreversibly stopped beating, but ethical and technical challenges remain. In the United States, heart transplantation relies on organs donated after brain death (DBD), thereby limiting the amount of hypoxia to the heart, which is continuously perfused until it is removed from the deceased donor. “I think studies like ours provide reassurance to transplant centers that heart transplantation from well-selected DCD donors appears to be safe and feasible,” lead investigator Shivank Madan, MD, MHA (Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY), told TCTMD, adding that further studies with longer follow-up-5 years or more-are still needed.
In a finding that could dramatically expand the pool of donor organs, a new observational study shows that hearts donated for transplantation following circulatory death yield similar outcomes at 30 days and 6 months when compared with hearts donated after brain death.Įxpanding the criteria to include hearts donated after circulatory death (DCD) could contribute potentially nearly 300 additional adult hearts for transplant in the United States, say researchers.
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