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Review
. 2020 Aug;36(Suppl 2):224-232.
doi: 10.1007/s12055-020-00998-x. Epub 2020 Aug 15.

DCD donations and outcomes of heart transplantation: the Australian experience

Kumud Dhital  1   2 , Prakash Ludhani  3 , Sarah Scheuer  2   4 , Mark Connellan  4 , Peter Macdonald  2   4
Affiliations
Review

DCD donations and outcomes of heart transplantation: the Australian experience

Kumud Dhital et al. Indian J Thorac Cardiovasc Surg. 2020 Aug.

Abstract

Purpose: There is increasing clinical utilization of hearts from the donation after circulatory death (DCD) pathway with the aim of expanding the donor pool and mitigating the ever-present discrepancy between the inadequate availability of good quality donor hearts and the rising number of patients with end-stage heart failure.

Methods: This article reviews the rationale, practice, logistical factors, and 5-year experience of DCD heart transplantation at St Vincent's Hospital, Sydney.

Findings: Between July 2014 and July 2019, 69 DCD donor retrievals were undertaken resulting in 49 hearts being instrumented on an ex situ normothermic cardiac perfusion device. Seventeen (35%) of these hearts were declined and the remaining 32 (65%) were used for orthotopic DCD heart transplantation. At 5 years of follow-up, the 1-, 3-, and 5-year survival was 96%, 94%, and 94% for DCD hearts compared with 89%, 83%, and 82% respectively for donation after brain death (DBD) hearts (n.s). The immediate post-implant requirement for temporary extra-corporeal membrane oxygenation (ECMO) support for delayed graft function was 31% with no difference in rejection rates when compared with the contemporaneous cohort of patients transplanted with standard criteria DBD hearts.

Summary: DCD heart transplantation has become routine and incorporated into standard clinical practice by a handful of pioneering clinical transplant centres. The Australian experience demonstrates that excellent medium-term outcomes are achievable from the use of DCD hearts. These outcomes are consistent across the other centres and consequently favour a more rapid and wider uptake of heart transplantation using DCD donor hearts, which would otherwise be discarded.

Keywords: Cardiac transplantation; Donation after circulatory death; Extra-corporeal heart perfusion.

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Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Breakdown of all DCD heart retrievals between July 2014 and July 2019. Did Not Progress (DNP)
Fig. 2
Fig. 2
Conglomerate arterial and venous lactate profiles of the 46 DCD hearts during ex situ reperfusion on the TransMedics OCS-Heart, of which 14 were declined for inadequate functional recovery
Fig. 3
Fig. 3
The Kaplan-Meijer survival curve for all DCD and DBD heart transplants between July 2014 and July 2019. There is no statistically significant difference between the two survival curves
See this image and copyright information in PMC

References

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