Early Experience of Donation After Circulatory Death Heart Transplantation Using Normothermic Regional Perfusion in the United States

Abstract Objective This pilot study sought to evaluate the feasibility of our donation after circulatory death (DCD) heart transplant protocol using cardiopulmonary bypass (CPB) for normothermic regional reperfusion (NRP). Methods Suitable local DCD candidates were transferred to our institution. Life support was withdrawn in the operating room (OR). Upon declaration of circulatory death, sternotomy was performed and the aortic arch vessels were ligated. CPB was initiated with left ventricular venting. The heart was reperfused with correction of any metabolic abnormalities. CPB was weaned and cardiac function assessed at 30-minute intervals. If accepted, the heart was procured with cold preservation and transplanted into recipients in a nearby OR. Results From January 2020 to January 2021, a total of 8 DCD heart transplants were performed: six isolated hearts, one heart-lung, and one combined heart-kidney. All donor hearts were successfully resuscitated and weaned from CPB without inotropic support. Average lactate and potassium levels decreased from 9.39 ± 1.47 mmol/L to 7.20 ± 0.13 mmol/L and 7.49 ± 1.32 mmol/L to 4.36 ± 0.67 mmol/L, respectively. Post-transplant, the heart-lung recipient required venoarterial extracorporeal membrane oxygenation for primary lung graft dysfunction, but was decannulated on postoperative day 3 and recovered uneventfully. All other recipients required minimal inotropic support without mechanical circulatory support. Survival was 100% with median follow-up of 304 days (interquartile range, 105–371 days). Conclusions DCD heart transplant outcomes have been excellent. Our DCD protocol is adoptable for more widespread use, and will increase donor availability in the United States.