The Organ Care System Training Manual for Hearts Donated after Circulatory Death: The Experience of One UK Centre after 50 Successful DCD Heart Transplants

Purpose The Organ Care System (OCS) is used to assess heart function following donation after circulatory death (DCD). We trained a small group of non-medical practitioners who are members of the National Organ Retrieval Services (NORS). A competency pack has been designed at Royal Papworth Hospital and includes a Standard Operating Procedure (SOP) and competencies for using this equipment. It is anticipated that national guidelines for using this equipment will be necessary and this guide acts as a benchmark for best practice based on the experience of a centre which has the greatest volume of data on DCD heart retrieval using the OCS in the UK. Methods Training has been undertaken at Transmedics Headquarters in Andover alongside in-house training. With the utilisation of reflection on best practice we designed a guide to facilitate safe practice with the OCS, supplemented with competencies to ensure gold standards in using this novel equipment. The SOP contains; questions and answers, a troubleshooting guide, pictures of equipment to aid correct setting up and competencies to ensure safe practice. Results From March 2015 to October 2018 we have transplanted 50 hearts from DCD donors. The team also attended 17 potential DCD heart donors of which 5 were placed on the OCS but not transplanted. The reasons for this included receiving additional information about the donor regarding potential malignancy and the presence of coronary artery disease. In one case coronary angiogram was performed on the OCS which confirmed coronary artery disease. 12 donor hearts were not perfused on the OCS, this was due to either the donor not meeting criteria at withdrawal of treatment or not meeting standard criteria for transplant to proceed. In addition to the procedural lessons learnt, logistical issues have arisen and contributed towards the development of the SOP. This experience has provided a depth of knowledge beyond training alone. Conclusion Upon the successful transplantation of 50 hearts retrieved from DCD donors using the OCS it was felt that the development of The OCS Training Manual was a key element in the success of this program. This manual has enabled consistency in practice and dissemination of information to ensure that lessons learnt are shared amongst this specialist team of OCS operators.