Interactive cardiovascular and thoracic surgery | 2019
Establishing a heart transplant programme using donation after circulatory-determined death donors: a United Kingdom based single-centre experience.
Abstract
OBJECTIVES\nDemand for heart transplant donors worldwide continues to outstrip supply. Transplanting hearts following donation after circulatory-determined death (DCD) is increasingly recognized as a safe and effective alternative. As the fourth centre worldwide to have established such a programme, our goal was to present our initial experience.\n\n\nMETHODS\nThis was a single-centre retrospective observational study. All DCD hearts were retrieved using direct procurement and perfusion. Continuous normothermic perfusion of the procured heart was then established on the TransMedicsĀ® Organ Care System. The primary outcome of this study was the 30-day survival rate.\n\n\nRESULTS\nBetween May 2017 and December 2018, 8 DCD hearts were procured and 7 were subsequently implanted, including in 2 patients who had left ventricular assist devices explanted. During the same time period, 30 patients received donation after brainstem death heart transplants. Therefore, the DCD heart transplant programme led to a 23% increase in transplant activity. The median donation warm ischaemic time was 34\u2009min [interquartile range (IQR) 31-39\u2009min]. The median functional warm ischaemic time was 28\u2009min (IQR 25-30\u2009min). The median time spent by the organ on the Organ Care System was 263\u2009min (IQR 242-296\u2009min). The overall 30-day survival rate was 100% and the 90-day survival rate was 86%. Postoperative extracorporeal membrane oxygenation was required in 3/7 (43%).\n\n\nCONCLUSIONS\nDCD heart transplants can lead to a 23% increase in heart transplant activity and should be adopted by more institutions across the world. Already established transplant programmes with good early outcomes can start such a programme safely.