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Donation After Circulatory Death Donor Use

  • Marijan Koprivanac
  • Nader Moazami
Living reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)

Abstract

Strategies for procurement of the heart from brain dead donors (DBD) have been standardized over the past 3 decades and limited by the period of warm and cold ischemic time with acceptable total ischemic time of 4–5 h. This landscape has remained largely unchanged until relatively recent development of pumping systems for continued warm perfusion of the heart during transport. Although these technologies for ex-vivo perfusion were initially used for improved organ preservation, recent trials have evaluated the use of this type of technology for resuscitating hearts that would otherwise not be accepted for transplantation to increase the availability of the heart organ. An extension of this methodology has been the quest to reevaluate the potential for recovering hearts from donors who have neurologic function, and therefore are not legally brain dead, but in whom because of an irreversible condition the decision has been made to withdraw life support until circulation ceases; this group of donors are referred to as Donation after Circulatory Death (DCD). Although this strategy has now been widely applied to lungs, livers, and kidneys increasing the availability of these organs by about 10%, applicability to cardiac allograft donation has been limited. This chapter will discuss the process of DCD donation, the pathologic concerns related to the heart, and current existing technologies that have been used for DCD heart transplantation.

Keywords

DCD heart Donation after circulatory death Warm ischemia Reperfusion injury OCS Ex-vivo heart perfusion Organ care system Normothermic regional perfusion NRP Heart postconditioning 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Cardiothoracic SurgeryCleveland ClinicClevelandUSA
  2. 2.Case Western UniversityClevelandUSA
  3. 3.Department of Cardiothoracic SurgeryNYU Langone Medical CenterNew YorkUSA

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