Jacobi Medical Center, New York City Health & Hospitals Corp, Bronx, NY (A.K., J.S., S.P.).
Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (S.N., M.U., D.J.G., S.R.P., D.B.S., U.P.J.).
Circ Heart Fail. 2024 Jul;17(7):e011678. doi: 10.1161/CIRCHEARTFAILURE.124.011678. Epub 2024 Jun 20.
Orthotopic heart transplant is the gold standard therapeutic intervention for patients with end-stage heart failure. Conventionally, heart transplant has relied on donation after brain death for organ recovery. Donation after circulatory death (DCD) is the donation of the heart after confirming that circulatory function has irreversibly ceased. DCD-orthotopic heart transplant differs from donation after brain death-orthotopic heart transplant in ways that carry implications for widespread adoption, including differences in organ recovery, storage and ethical considerations surrounding normothermic regional perfusion with DCD. Despite these differences, DCD has shown promising early outcomes, augmenting the donor pool and allowing more individuals to benefit from orthotopic heart transplant. This review aims to present the current state and future trajectory of DCD-heart transplant, examine key differences between DCD and donation after brain death, including clinical experiences and innovations in methodologies, and address the ongoing ethical challenges surrounding the new frontier in heart transplant with DCD donors.
原位心脏移植是治疗终末期心力衰竭患者的金标准治疗干预措施。传统上，心脏移植依赖于脑死亡后的捐赠来获取器官。循环死亡后捐献（DCD）是在确认循环功能不可逆转停止后捐献心脏。DCD-原位心脏移植与脑死亡-原位心脏移植的不同之处在于广泛采用的方式存在差异，包括器官回收、存储以及围绕 DCD 体温区域灌注的伦理考虑。尽管存在这些差异，但 DCD 已显示出有希望的早期结果，增加了供体池，使更多人受益于原位心脏移植。本综述旨在介绍 DCD-心脏移植的现状和未来发展轨迹，检查 DCD 与脑死亡之间的关键差异，包括临床经验和方法学方面的创新，并解决 DCD 供体心脏移植这一新领域中持续存在的伦理挑战。
