Duke Doctors Successfully Transplant Heart After Cardiac Death
Dr KK Aggarwal
President CMAAO and HCFI
A potential organ donor is typically a mechanically ventilated patient in an ICU with brain death (donation after brain death or DBD) or cardiac death (donation after cardiac death or DCD).
Nearly all heart donations are DBD and there has been very limited experience with DCD.
Duke University Hospital in Durham, North Carolina team transplanted heart using donation after cardiac death (DCD).
The team used the TransMedics Organ Care System (OCS) to perfuse the heart, which had stopped beating, with warm blood after it had been procured. The heart then remained on the OCS until it was transplanted into the recipient.
Resuscitating organs is a key component in the evaluation and potential use of DCD. For hearts, this involves resuscitating and then excising a donor heart after cardiac arrest. Case series in Australia and England have demonstrated the potential utility of using this type of cardiac donor
There have now been over 100 DCD heart transplants worldwide.
DCD is the "next evolution" in heart transplantation methods, although it has been used for many years in procuring other organs such as lungs, liver, and kidneys.
In children, Donation after circulatory determination of death (DCDD) refers to a donor that does not meet criteria for brain death, but has no hope of any sort of meaningful neurologic recovery, and in whom the family chooses to withdraw life-sustaining treatment. After death is determined using circulatory criteria (permanent absence of respiration, circulation, and responsiveness), organs may be recovered for transplantation. This type of donation has previously been referred to as non-heart-beating organ donation (NHBD), or donation after cardiac death (DCD).