Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: We successfully planned, procured and transplanted a heart after a Donation After Cardiac Death (DCD) protocol with post-declaration implementation of in vivo cardiopulmonary bypass for the donor.
*Methods: The algorithm and protocol for DCD candidates were developed collaboratively by the cardiac transplant (TXP) and organ procurement organization (OPO) teams. Institutional Review Board (TXP Center) and Medical Advisory Board (OPO) approvals and collaboration with all cardiac and hepatic TXP teams within the donor service area were obtained. UNOS allocation policy was strictly adhered to. Once determined a suitable candidate, the 43 year old donor was transported to the TXP center where the critical care team managed all pre-mortem care. Conventional extubation and comfort care took place in the operating room with perfusion and procurement teams on standby. Following declaration and a five minute observation period, the chest was opened, the aortic arch branches supplying arterial flow to the brain were clamped, and cardiopulmonary bypass was initiated.
*Results: As noted in Table 1, the patient expired 24 minutes following extubation. Following a five minute waiting period (per hospital policy), cardiopulmonary bypass was initiated within 12 minutes.
As per standard cardiac procedure, bypass was weaned off with reanimation of the donor heart. Laboratory values demonstrating the reversal of acidosis (developed during the agonal phase) are shown below.
The waiting recipient was then anesthetized and prepared for TXP. The donor heart was cross-clamped 117 minutes after bypass was initiated. The TXP was uneventful with prompt function of the heart. The patient was extubated on postoperative day 1 and discharged on day 14.
*Conclusions: Post-mortem cardiopulmonary bypass in this heart only DCD donor facilitated TXP of a heart that would not otherwise have been utilized. We anticipate that multi-organ DCD donation that includes recovery of suitable hearts and follows UNOS allocation policy will provide a significant number of transplantable hearts that would otherwise not have available.
|Brain vessels clamped||17:12|
|Bypass weaned off||17:56|
|Baseline||3 mins on bypass||18 mins on bypass||23 mins on bypass||33 mins on bypass|
To cite this abstract in AMA style:Friedman AL, Kon ZN, Smith DE, Sullivan B, Carillo J, Moazami N. First U.S. DCD Heart Procured/Transplanted after Normothermic Regional Perfusion [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/first-u-s-dcd-heart-procured-transplanted-after-normothermic-regional-perfusion/. Accessed October 24, 2020.
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