Hospitals pioneer methods to overcome DCD barriers, expand lifesaving transplants

Editor's Note

Surgeons at Duke and Vanderbilt universities have devised simpler methods to retrieve donor hearts after circulatory death, according to a July 16 report from the Associated Press (AP).

The research, published in the New England Journal of Medicine, details successful heart transplants using organs from donors whose hearts had stopped—a category known as donation after circulatory death (DCD). The methods offer alternatives to current DCD techniques, which often rely on ethically controversial procedures or expensive machines that cannot be used for pediatric patients. 

According to The AP, Duke’s team removed the heart and, on a sterile table in the operating room, briefly attached tubes that supplied oxygen and blood to assess its ability to function. This approach was successfully used to transplant a heart from a 1-month-old donor to a 3-month-old recipient after being tested on piglets.

Vanderbilt’s method, The AP reports, involves infusing the heart with a cold, nutrient-rich preservative solution before removal, similar to the approach used with hearts from brain-dead donors. Vanderbilt has performed about 25 such transplants using this technique.

As detailed in the article, most transplanted hearts come from brain-dead donors maintained on ventilators until organ removal. In contrast, DCD hearts stop beating when life support is withdrawn, and the brief lack of oxygen can raise questions about organ viability. Some hospitals attempt to restore circulation to the heart after death using normothermic regional perfusion (NRP), but the technique is ethically controversial and banned in certain facilities. Another option uses perfusion machines to reanimate DCD hearts in transit, but the devices are reportedly complex, expensive, and unsuitable for young children.

The AP notes that in 2023, individuals who died via circulatory death accounted for 43% of the nation’s deceased donors, yet only 793 of the 4,572 heart transplants used DCD hearts. About 700 children are added to the U.S. transplant waitlist for a new heart each year, and approximately 20% die while waiting.