Cardiac Transplantation Utilizing Donation After Circulatory Death (DCD)
Donation after circulatory death was historically referred to as non-heart-beating donation. Maastricht category III donors remain the only group relevant to heart donation at present. Each donor hospital has its own policy for the location of withdrawal of life support, which may also depend on family wishes and presence. There are two distinct protocols: direct procurement and normothermic regional perfusion (NRP); these have evolved due to different ethical and legal requirements of the jurisdiction. The objective of direct procurement is to achieve a cold flush of each organ as expeditiously as possible and then explant the organ. The objective with NRP is to achieve reperfusion of the heart and other organs as quickly as possible. Use of a portable ex-situ perfusion apparatus is essential to the direct procurement technique, with the TransMedics Organ Care System Heart being the only device in widespread use and commercially available.
