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DCD Hearts at a Distance


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Peter MacDonald, MD, PhD
St. Vincent's Hospital
Sydney, NSW, AUSTRALIA
peter.macdonald@svha.org.au



St Vincent's Hospital, Sydney announces the world's first heart transplants from DCD donors using normothermic ex vivo heart perfusion with the Transmedics Organ Care System.

Professors Peter Macdonald and Kumud Dhital from St Vincent's Hospital in Sydney Australia recently announced that the Heart Transplant Unit had performed 3 successful heart transplants from DCD donors. All 3 recipients have recovered well and have been discharged from the hospital. The first patient is now over 4 months post-transplant. In contrast to previous DCD heart transplants, in which donor and recipient were co-located in the same hospital, the donors for these transplants were located in separate hospitals. This includes two instances where the donor hospital was in another state and air transport was required to convey the donor heart to St Vincent's Hospital.

Key steps to establishing a clinical heart transplant service from DCD donors are (i) the development of a flush solution that 'post-conditions' the DCD heart, increasing its tolerability to warm ischemia, (ii) use of ex vivo oxygenated blood perfusion to prevent further myocardial ischemia, and (iii) use of normothermic ex vivo perfusion to allow reanimation of the heart and assessment of its viability. Preclinical studies to establish these steps were conducted at the Victor Chang Cardiac Research Institute. The results of these studies were published this year in the American Journal of Transplantation and provided the scientific underpinning to allow successful translation of DCD heart transplantation into the clinic. By going the distance, utilization of DCD donors has been projected to increase heart transplant numbers up to 30%.

A symposium on heart transplantation from DCD and marginal brain dead donors will be one of the highlights of the upcoming Nice Meeting. ■

Disclosure Statement: The author has no conflicts of interest to disclose.




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