The Donation after Circulatory Death Donor can be a Source of Organs for Cardiac Transplantation

The number of heart transplants performed worldwide is declining annually [1-3]. The conventional source of donor hearts, the brainstem dead cadaveric heart-beating donor. is decreasing. Advances in neurosurgical treatment of patients with severe head injury and intracranial haemorrhage (ICH) mean that the increase in intracranial pressure (ICH) which previously precipitated ischemic brain-stem death can now be retarded or alleviated. The donation after circulatory death (DCD) donor is being increasingly used for transplantation. Successful renal, hepatic and pulmonary transplantation using nonheart beating donors has been reported [4-8]. With respect to cardiac donation it has been assumed that the heart would suffer overwhelming ischemic damage as a result of warm ischemia associated with nonheart beating donation. The Maastricht criteria were devised to classify non-heart beating donors according to whether cardiac arrest occurs under controlled or uncontrolled circumstances [9]. Category I & II suffer either an out of hospital or in-hospital uncontrolled cardiac arrest. In this group warm ischemic times are longer and organs may be irreversibly damaged. Category III donors suffer a cardiac arrest in a controlled setting following the elective withdrawal of supportive therapy. In these circumstances the duration of warm ischemia can be minimized, limiting organ injury. We have recently demonstrated recovery of cardiac function in human controlled DCD donors. This was achieved through in-vivo coronary reperfusion 23 minutes after asystole using an extracorporeal circuit. The resuscitated heart was subsequently able to independently support the circulation of the donor [10]. Our regional program for non-heart beating kidney donation is one of the largest in the world [7]. We retrospectively analyzed DCD donors who were procured for renal and hepatic transplantation to ascertain whether cardiac donation from this group may have been suitable based on their pre-terminal cardiovascular status and comorbidities.