Heart transplantation is the definitive treatment for refractory, end-stage heart failure. The number of patients awaiting transplantation far exceeds available organs. In an effort to expand the donor pool, donation after circulatory death (DCD) heart transplantation has garnered renewed interest. Unlike donation after brain death, DCD donors do not meet the criteria for brain death and are dependent on life-sustaining therapies. Procurement can include a direct strategy or a normothermic regional perfusion, whereby there is restoration of perfusion to the organ before explantation. There are new developments in cold storage and ex vivo perfusion strategies. Since its inception, there has been a steady improvement in post-transplant outcomes, largely attributed to advancements in operative and procurement strategies. In this narrative review, the authors address the unique considerations of DCD heart transplantation, including withdrawal of care, the logistics of procuring and resuscitating organs, outcomes compared with standard donation after brain death, and ethical considerations.
Keyphrases
- heart failure
- resting state
- end stage renal disease
- white matter
- chronic kidney disease
- healthcare
- functional connectivity
- ejection fraction
- newly diagnosed
- contrast enhanced
- prognostic factors
- squamous cell carcinoma
- peritoneal dialysis
- left ventricular
- palliative care
- quality improvement
- multiple sclerosis
- metabolic syndrome
- computed tomography
- adipose tissue
- mesenchymal stem cells
- locally advanced
- decision making
- radiation therapy
- bone marrow
- atrial fibrillation
- subarachnoid hemorrhage
- brain injury
- glycemic control
- smoking cessation
- patient reported