Adult: Transplant| Volume 164, ISSUE 2, P557-568.e1, August 2022

Early experience with donation after circulatory death heart transplantation using normothermic regional perfusion in the United States

Published:September 14, 2021DOI:



      This pilot study sought to evaluate the feasibility of our donation after circulatory death (DCD) heart transplantation protocol using cardiopulmonary bypass (CPB) for normothermic regional reperfusion (NRP).


      Suitable local DCD candidates were transferred to our institution. Life support was withdrawn in the operating room (OR). On 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 was assessed at 30-minute intervals. If accepted, the heart was procured with cold preservation and transplanted into recipients in a nearby OR.


      Between January 2020 and January 2021, a total of 8 DCD heart transplants were performed: 6 isolated hearts, 1 heart-lung, and 1 combined heart and 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-transplantation, the heart-lung transplant 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 a median follow-up of 304 days (interquartile range, 105-371 days).


      DCD heart transplantation outcomes have been excellent. Our DCD protocol is adoptable for more widespread use and will increase donor heart availability in the United States.

      Graphical abstract

      Key Words

      Abbreviations and Acronyms:

      CPB (cardiopulmonary bypass), DBD (donation after brain death), DCD (donation after circulatory death), DPP (direct procurement and perfusion), ECMO (extracorporeal membrane oxygenation), ICU (intensive care unit), LOS (length of stay), LVEF (left ventricular ejection fraction), NRP (normothermic regional perfusion), NYULH (New York University Langone Health), OCS (Organ Care System), OPO (Organ Procurement Organization), OR (operating room), PGD (primary graft dysfunction), POD (postoperative day), WIT (warm ischemia time), WLST (withdrawal of life-sustaining therapy)
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      Linked Article

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        The Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 2
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          Use of donation after circulatory death (DCD) hearts could significantly extend cardiac transplantation's therapeutic reach. Smith and colleagues1 should be congratulated on their pioneering work in which they report the first successful use of the normothermic regional perfusion (NRP) technique in an adult DCD heart program in the United States. These authors describe an innovative protocol that relocated potential donor patients to the New York University Medical Center for the purpose of organ donation.
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      • Commentary: An innovative strategy for expanding the donor pool
        The Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 2
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          Heart transplantation continues to be constrained by a limited supply of donor organs. In an effort to expand the US donor pool, the use of allografts from donation after circulatory death (DCD) donors is currently being investigated. Early reports have estimated that the adoption of DCD heart transplantation may lead to an increase in overall heart transplant volume by as much as 30%.1,2 Indeed, our center has seen a recent increase in volume of approximately 30%, largely due to the use of DCD donors.
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        • PDF