Simon Messer, a specialist trainee registrar in cardiothoracic surgery and a researcher on heart donation after cardiac death (DCD) at the Royal Papworth Hospital in the UK, presents his center’s experience on DCD heart transplantation as means of increasing the donor pool and reducing the waiting times for heart transplant recipients.
This lecture was presented during the Glasgow Cardiopulmonary Transplantation and Mechanical Circulatory Support Symposium, a one-day symposium held at the Golden Jubilee National Hospital in Glasgow, UK.
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CITATION
Khorsandi M, Curry P, Messer S. Donation After Cardiac Death Heart Transplantation: The New Frontier. May 2019. doi:10.25373/ctsnet.8178686.
2 Comments
Thanks for this exciting concept.However any organ can only be retrieved after brain Death of a patient. so I am confused or could not understand the difference between DBD &DCD transplant .Could you please explain to clarify it further .Congratulations and history is rewritten in transplant surgery!
Dr. Mishra many thanks for your enquiry. DCD heart procurement is indeed a very exciting and relatively new approach to increasing the donor pool for heart transplantation. Traditionally DBD donors meet criteria for brainstem death (e.g. absent corneal reflexes, no respiratory effort after sedation wean etc) vs. DCD donors who do not necessarily meet the brainstem death criteria (however, may still have severe irreversible cerebral damage) but do not have any realistic prospect of recovery and are “expected to go into cardiac arrest” (Category III DCD Maastricht criteria) due to the severity of their disease and remain on plenty of haemodynamic and respiratory support, but their heart (+/- other organs) is intact and is suitable for transplantation. In such cases when the consent is obtained, in a controlled environment (i.e. the ICU/operating theatre depending on local protocol) all support is weaned off which would, in most cases, lead to an agonal phase of circulation (hypotension) and eventually cardiac arrest. Following mechanical circulatory arrest (of usually of about 5 min depending on local protocol) the surgical team immediately open the chest and procure the heart (the direct DCD procurement technique) and placed on an organ care system device to resume perfusion or using normothermic regional perfusion (NRP) as per presentation above.