Donation after cardiac death (DCD)
Heart transplantation with DCD
In the most advanced heart failure, transplantation of a donor heart remains the gold standard for improving quality of life and survival. Unfortunately, heart transplantation is available to only a fraction of those who need it because of the constant shortage of available donors.
One solution to increase donor organ availability is through the use of organs obtained through donation after circulatory death (DCD). DCD is becoming increasingly predominant as a source of organs in kidney, liver, pancreas and lung transplantation. However, DCD organs inevitably undergo a period with no blood flow (ischemia), which rapidly leads to tissue injury. The particular susceptibility of the heart to ischemic injury, has therefore led to reluctance towards the use of DCD cardiac grafts.
Importantly, several recent reports of successful clinical DCD heart transplantations attest to its feasibility as a solution to cardiac graft shortages. Furthermore, estimates indicate that cardiac graft availability would be substantially increased with the adoption of DCD, both for children and adults.
Although these encouraging results demonstrate a promising potential for cardiac grafts procured with DCD, evidence-based approaches to achieve optimal outcomes are urgently needed. With our research, the overall goals are to identify clinically applicable strategies for DCD in order to limit injury (and thereby maximize post-transplant cardiac function), and to enable early cardiac graft evaluation for transplantation suitability. With these strategies, we aim to facilitate DCD heart transplantation, and ultimately to improve cardiac graft availability.