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  • Review Article
  • Published:

Heart transplantation with donation after circulatory determination of death

Nature Reviews Cardiology volume 11, pages 354–363 (2014)Cite this article

Subjects

Key Points

  • Shortage of organs limits the number of heart transplantations performed; waiting-list mortality is 10–12% per year in Europe and the USA

  • Adoption of donation after circulatory determination of death (DCDD) in heart transplantation could substantially improve organ availability for both adults and children

  • Very limited clinical evidence already supports the feasibility of heart transplantation with DCDD

  • Tissue injury resulting from exposure of the donor heart to warm, noncardioplegic ischaemia before procurement is the major obstacle for DCDD in heart transplantation

  • Strategies for procurement, storage, and evaluation must be optimized for DCDD in heart transplantation; effective approaches remain to be identified

  • Establishment of DCDD in heart transplantation also requires careful consideration of ethical and legal aspects

Abstract

The constant shortage of available organs is a major obstacle and limiting factor in heart transplantation; the discrepancy between the number of donors and potential recipients leads to waiting-list mortality of 10–12% per year in Europe and the USA. If adopted for heart transplantation, donation after circulatory determination of death (DCDD) would be expected to improve the availability of organs substantially for both adults and children. With DCDD, however, hearts to be transplanted undergo a period of warm ischaemia before procurement, which is of particular concern because tissue damage occurs rapidly and might be sufficient to preclude transplantation. Nonetheless, the heart is able to withstand limited periods of warm ischaemia, which could provide a window of opportunity for DCDD. Development of clinical approaches specifically for DCDD is critical for the exploitation of these organs, because current practices for donor heart procurement, evaluation, and storage have been optimized for conventional donation after brain death, without consideration of warm ischaemia before organ procurement. Establishment of clinical protocols and ethical and legal frameworks for DCDD of other organs is underway. This Review provides a timely evaluation of the potential for DCDD in heart transplantation.

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Figure 1: Events surrounding donor death result in exposure of the heart to variable conditions before access for organ procurement.
Figure 2: Windows of opportunity for potential cardioprotective interventions in various categories of donors for cardiac DCDD.

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Acknowledgements

To limit the number of references, reviews have occasionally been cited and the authors apologize to the authors of original papers for not citing them directly. The authors thank L. Seidel (Department of Cardiovascular Surgery, Inselspital, Berne University Hospital and University of Berne, Switzerland) for administrative assistance. The authors are supported by the Swiss National Science Foundation (grant number 310030_149730).

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  1. Department of Cardiovascular Surgery, Inselspital, Berne University Hospital and University of Berne, Murtenstrasse 35, CH-0310, Switzerland

    Sarah L. Longnus, Veronika Mathys, Monika Dornbierer, Florian Dick, Thierry P. Carrel & Hendrik T. Tevaearai

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  1. Sarah L. Longnus
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  2. Veronika Mathys
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  3. Monika Dornbierer
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  4. Florian Dick
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  6. Hendrik T. Tevaearai
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Contributions

S.L.L., V.M., and H.T.T. researched data for the article. S.L.L., M.D., F.D., T.P.C., and H.T.T. contributed substantially to discussion of its content. S.L.L, V.M., M.D., and H.T.T. wrote the manuscript, and S.L.L., F.D., T.P.C., and H.T.T. reviewed/edited the article before submission.

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Correspondence to Hendrik T. Tevaearai.

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The authors declare no competing financial interests.

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Longnus, S., Mathys, V., Dornbierer, M. et al. Heart transplantation with donation after circulatory determination of death. Nat Rev Cardiol 11, 354–363 (2014). https://doi.org/10.1038/nrcardio.2014.45

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