Department of Cardiovascular Surgery, Inselspital, Berne University Hospital and University of Berne, Murtenstrasse 35, CH-0310, Switzerland.
Nat Rev Cardiol. 2014 Jun;11(6):354-63. doi: 10.1038/nrcardio.2014.45. Epub 2014 Apr 15.
The constant shortage of available organs is a major obstacle and limiting factor in heart transplantation; the discrepancy between the number of donors and potential recipients leads to waiting-list mortality of 10-12% per year in Europe and the USA. If adopted for heart transplantation, donation after circulatory determination of death (DCDD) would be expected to improve the availability of organs substantially for both adults and children. With DCDD, however, hearts to be transplanted undergo a period of warm ischaemia before procurement, which is of particular concern because tissue damage occurs rapidly and might be sufficient to preclude transplantation. Nonetheless, the heart is able to withstand limited periods of warm ischaemia, which could provide a window of opportunity for DCDD. Development of clinical approaches specifically for DCDD is critical for the exploitation of these organs, because current practices for donor heart procurement, evaluation, and storage have been optimized for conventional donation after brain death, without consideration of warm ischaemia before organ procurement. Establishment of clinical protocols and ethical and legal frameworks for DCDD of other organs is underway. This Review provides a timely evaluation of the potential for DCDD in heart transplantation.
可供移植的器官持续短缺是心脏移植的主要障碍和限制因素；在欧洲和美国，供体与潜在受者人数之间的差异导致每年等待名单上的死亡率为 10%-12%。如果将其用于心脏移植，心跳停止判定后的捐献（DCDD）有望大幅增加供体器官数量，无论成人还是儿童均能受益。然而，在 DCDD 中，待移植的心脏在获取前会经历一段时间的热缺血，这是一个特别令人关注的问题，因为组织损伤发生迅速，可能足以排除移植。尽管如此，心脏能够承受有限的热缺血期，这可能为 DCDD 提供一个机会窗口。专门针对 DCDD 的临床方法的开发对于这些器官的利用至关重要，因为目前用于供体心脏获取、评估和储存的方法是针对传统的脑死亡后捐献而优化的，而没有考虑器官获取前的热缺血。为 DCDD 其他器官制定临床方案以及伦理和法律框架的工作正在进行中。本综述及时评估了 DCDD 在心脏移植中的潜力。
