This method requires harvesting 1100 mL donor blood for OCS machine priming prior to heart recovery. TransMedics Organ Care System (OCS™) (Andover, MA, USA) is the only FDA-approved system for ex situ perfusion of DCD hearts. After confirmation of circulatory death, the heart is flushed with cold crystalloid cardioplegia and procured, followed by back table instrumentation and reperfusion with normothermic blood. Two techniques for DCD heart procurement have emerged: direct procurement and ex situ perfusion (DPP) and normothermic regional in situ perfusion (NRP). Estimates suggest that DCD hearts can increase the donor pool by as much as 50%. Recent improvements in machine perfusion (MP) have allowed resuscitation of DCD hearts and successful transplant. DCD hearts experience severe ischemic injury, to the point of loss of pump and electrical function. Ischemic injury is a major risk to all donor organs. Following a standoff period of typically 5 minutes, circulatory death is reconfirmed prior to proceeding with organ procurement. Following withdrawal of care, the donor expires, and death is declared on circulatory basis (no blood pressure, pulse, or heartbeat). Circulatory death donors do not meet full brain death criteria, but have suffered devastating, irreversible injuries and further care is futile. Scheduled organ evaluation and procurement in DBD donors is a well-established process, whereby organ function is arrested with cold solution flushing. Brain death is declared when all brain functions have ceased. 1ĭeceased donor organ donation proceeds after declaration of brain death (DBD) or circulatory death (DCD). Therefore, transplant programs use marginal donors with risk factors including older age, size mismatch, left ventricular hypertrophy, low ejection fraction, and longer donor ischemic times. Organ availability is the main factor limiting access to heart transplantation. Courtesy of Lee C, Tsai C, Adler E, Pretorius V.
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