Donation after circulatory death heart transplant

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VIDEO ARTICLE

Donation after circulatory death heart transplant Om Prakash Yadava 1

# Indian Association of Cardiovascular-Thoracic Surgeons 2020

Abstract Dr. O.P. Yadava, CEO and Chief Cardiac Surgeon, National Heart Institute, New Delhi, India, and Editor-in-Chief, Indian Journal of Thoracic and Cardiovascular Surgery, in a conversation with Dr. Catherine Dushyant Sudarshan, discusses the state of donation after circulatory death for cardiac transplant and how it can address the donor shortages. Keywords DCD heart . DBD heart . Heart transplant

Dr. Sudarshan comments that heart failure prevalence is probably underestimated and the demand for hearts far outstrips its supply. Not only is the awareness for organ donation absent in the public, especially in the developing world, it is lacking even in medical personnel working in the intensive care units (ICUs). Counting a positive development, albeit a negative one from transplant perspective, there has been a reduction in availability of good young hearts for organ transplantation. It is due to various factors like improved driving conditions, universal use of seat belts, reduction in drunk driving, advanced medical care, rapid response teams providing early resuscitation, and good ICU care. A new development to bridge this gap between donor availability and supply is the donation after circulatory death (DCD) [1]. Traditionally, we have been using donors who have been declared brain stem dead (DBD) by a non-transplant doctor and the heart is harvested with minimal ischemic time, as one can decide when to arrest the heart and preserve it. However, there may be patients who may not fulfill all the criteria for brain stem death, or may not be actually brain dead because of the presence of occasional spontaneous respiration or gag reflex. There may even be a third category, where the patient’s relatives may desire that the organs be donated, in what for all Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12055-020-01043-7) contains supplementary material, which is available to authorized users. * Om Prakash Yadava [email protected] 1

National Heart Institute, New Delhi, India

practical purposes is a cadaveric patient. Going through the nitty gritty of the DCD donation, she stresses that for DCD donation, 5 min of mechanical asystole is mandatory and a person has to be declared dead by a non-transplant doctor. Once the decision to harvest the organ is taken, the head and neck blood vessels are clamped and the patient is put on the standard cardiopulmonary bypass using the ECMO circuit and the heart is re-animated, thereby semantically and technically converting a DCD donor to a DBD donor. Thereafter, cardioplegia is instilled and the heart can be harvested and mounted on the organ perfusion system. The time between harvesting and mounting on the organ system should ideally be kept less than 30 min. The heart can be maintained on the organ care system for up to 6 h. Recounting Papworth’s experience, Dr. Dushyant warr