Expanding Heart Transplant Access with Circulatory Death Donation Technique

At the recent Annual Meeting of the International Society for Heart and Lung Transplantation (ISHLT), experts highlighted a breakthrough in organ transplantation: the advance of donation after circulatory death (DCD) for hearts. This innovative approach has significantly boosted the number of available donor hearts worldwide over the past decade.

DCD involves retrieving hearts from donors whose circulatory and respiratory functions have ceased, but who do not meet criteria for brain death. Historically, most heart donations came from brain-dead donors (DBD), a practice that has dominated since the establishment of brain death legislation in 1981. However, the modern DCD technique, developed over 10 years through research in Australia and the UK, has changed this landscape.

The first successful DCD heart transplant was carried out in 2014 at St. Vincent's Hospital in Sydney, followed by similar procedures in the UK at Royal Papworth Hospital in 2015. Recent trials, including a landmark 2022 randomized controlled trial in the US, demonstrated that outcomes with DCD hearts are comparable to those from traditional DBD donors. This has led to a surge in the adoption of DCD programs across the US and beyond.

Dr. Sarah Scheuer, a cardiothoracic surgeon involved in these advancements, notes that most centers implementing DCD programs see an approximately 30% increase in transplant volume, making it arguably the most significant shift in heart transplantation since the advent of modern immunosuppression.

Currently, over 250 DCD hearts have been transplanted by pioneering hospitals like St. Vincent's and Royal Papworth. The expansion of this technique is partly driven by the support from donor families, who often find DCD more acceptable than brain death criteria. Researchers are also exploring biomarkers to assess the viability of DCD hearts and developing better preservation methods, including perfusion techniques and regenerative medicine, to improve outcomes.

The innovations in DCD are offering renewed hope for patients with end-stage heart failure, increasing access to life-saving transplants and improving survival prospects. As this method continues to evolve, it holds the promise of transforming the future of heart transplantation around the world.