Surgical techniques for cardiac allograft procurement and perfusion in controlled donation after circulatory death

Abstract

In the last decade, heart transplants using allografts from adult donors after circulatory death, in a controlled setting, controlled donation after circulatory death (cDCD) have been rapidly adopted and widely performed. The selection of retrieval methods has largely been determined by state or institutional guidelines concerning permissible postmortem procedures. A significant majority of cDCD heart recoveries have employed direct procurement and perfusion (DPP) followed by normothermic machine perfusion (NMP) for graft preservation. Another established method involves the thoracoabdominal normothermic regional perfusion (taNRP), which is then followed by either NMP or static cold storage. Processing, management and surgical techniques of heart allograft procurement after cDCD are herein described and discussed.

Keywords: Heart transplantation; controlled donation after circulatory death (cDCD); direct procurement and perfusion (DPP); normothermic regional perfusion (NRP); organ care system (OCS).

Figure 1

Traditional pathway (DBD) and new pathway (DCD) for heart graft procurement.

Figure 2

Ex-situ machine perfusion cardiac allograft preservation device.

Figure 3

Ex-situ machine perfusion cardiac allograft preservation setting. (A) In the box; (B) out of the box. SvO₂, venous oxygen saturation

Figure 4

Arrangements for abdominal normothermic regional perfusion in donation after circulatory determination of death. (A) Open circuit; (B) closed circuit.

Figure 5

In-situ thoracoabdominal normothermic regional perfusion cardiac allograft preservation setting. (A) Circuit working; (B) circuit recirculation.

Figure 6

Temperature controlled cardiac allograft cold storage device.

Figure 7

Temperature controlled cardiac allograft arrangement for cold storage.