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अमूर्त

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

Ayyaz A. Ali, Darren Freed and Stephen Large

Objectives: The donation after circulatory death (DCD) donor is an increasing source of organs for transplantation. Currently cardiac donation from DCD donors is precluded due to concerns that circulatory arrest in the organ donor would result in ischemic myocardial injury. We have recently resuscitated a human DCD heart in-vivo using extracorporeal perfusion. Through a retrospective analysis of DCD organ donors procured for liver and kidney transplantation, we sought to determine what proportion may have been suitable for cardiac donation based on their past medical history and pre-terminal cardiovascular status.
Methods: Demographic data was obtained from individual hospital notes and standard donor information files. In order to assess their suitability for cardiac donation we carefully analyzed their cardiovascular status. In particular we reviewed hemodynamic parameters, the requirement for inotropic support and whether there was any past medical history of cardiovascular disease.
Results: Between May 1st 2003 and March 1st 2007, 67 DCD donors were consented for liver and kidney donation. Eleven DCD donors would have been excluded on the basis of a history of cardiac disease, eight of whom suffered a recent myocardial infarction. An additional three donors were considered to be hemodynamically unstable. The remaining 80% (53/67) had normal cardiac function and no history of cardiac disease.
Conclusions: Eighty-percent of DCD donors in our series may have been suitable for cardiac donation, based on their past history and cardiovascular status prior to donation. The use of hearts from DCD donors may allow for a significant expansion of the donor pool.