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An adult patient received a “donation after circulatory death” (DCD) heart transplant in the first such procedure to take place in the United States. Surgeons at Duke University Hospital in Durham, North Carolina, recently performed the operation as part of a clinical trial evaluating the Organ Care System (OCS) Heart, an investigational normothermic preservation system from Massachusetts-based TransMedics. An alternative to cold storage, the device keeps the donor heart pumping with warm oxygen- and nutrient-rich blood.
The first heart transplants were DCD procedures, but the field has since shifted to donation after brain death (DBD). Bringing back routine use of DCD could expand the donor heart pool by an estimated 30%, improving the chances of survival for the approximately 250 000 US patients with end-stage heart failure, Jacob N. Schroder, MD, surgical director of Duke’s heart transplant program, said in an email.
Surgeons have recently started to transplant more DCD lungs, livers, and kidneys. But the heart has a lower tolerance for warm ischemia time (WIT), the period after circulation stops and before the organ is perfused with a cold preservation solution.
Normothermic preservation could help to overcome this. “The OCS allows the heart to recover from the insult of the cessation of blood flow and WIT, to possibly be ‘rehabbed’ on the pump, and to avoid the continued insult of cold static storage,” said Schroder, who performed the procedure with colleagues last month.
The ongoing randomized trial will compare 6-month outcomes of more than 200 patients who will receive DCD or DBD heart transplants at 5 US centers over the next 2 years. A British study involving 50 DCD heart transplants recently found comparable 30-day outcomes for the 2 approaches.
Abbasi J. “Donation After Circulatory Death” Heart Transplant Is a US First. JAMA. 2020;323(2):111. doi:10.1001/jama.2019.21073
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