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DCD donations and outcomes of heart transplantation: the Australian experience

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

There is increasing clinical utilization of hearts from the donation after circulatory death (DCD) pathway with the aim of expanding the donor pool and mitigating the ever-present discrepancy between the inadequate availability of good quality donor hearts and the rising number of patients with end-stage heart failure.

Methods

This article reviews the rationale, practice, logistical factors, and 5-year experience of DCD heart transplantation at St Vincent’s Hospital, Sydney.

Findings

Between July 2014 and July 2019, 69 DCD donor retrievals were undertaken resulting in 49 hearts being instrumented on an ex situ normothermic cardiac perfusion device. Seventeen (35%) of these hearts were declined and the remaining 32 (65%) were used for orthotopic DCD heart transplantation. At 5 years of follow-up, the 1-, 3-, and 5-year survival was 96%, 94%, and 94% for DCD hearts compared with 89%, 83%, and 82% respectively for donation after brain death (DBD) hearts (n.s). The immediate post-implant requirement for temporary extra-corporeal membrane oxygenation (ECMO) support for delayed graft function was 31% with no difference in rejection rates when compared with the contemporaneous cohort of patients transplanted with standard criteria DBD hearts.

Summary

DCD heart transplantation has become routine and incorporated into standard clinical practice by a handful of pioneering clinical transplant centres. The Australian experience demonstrates that excellent medium-term outcomes are achievable from the use of DCD hearts. These outcomes are consistent across the other centres and consequently favour a more rapid and wider uptake of heart transplantation using DCD donor hearts, which would otherwise be discarded.

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Acknowledgements

The authors thank Dr. Helen Opdam, the National Medical Director of the Australian Organ & Tissue Authority, for collating information of the use of ante mortem heparin in the various Australian states.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery & Transplantation, Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia

    Kumud Dhital

  2. Transplant Laboratory, Victor Chang Cardiac Research Institute, Lowy Packer Building, 405 Liverpool St, Darlinghurst, NSW, 2010, Australia

    Kumud Dhital, Sarah Scheuer & Peter Macdonald

  3. Department of Cardiothoracic Surgery, MIOT Hospital, Chennai, India

    Prakash Ludhani

  4. Department of Cardiothoracic Surgery, St Vincent’s Hospital, Darlinghurst, Sydney, NSW, 2010, Australia

    Sarah Scheuer, Mark Connellan & Peter Macdonald

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  1. Kumud Dhital
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  2. Prakash Ludhani
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  4. Mark Connellan
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  5. Peter Macdonald
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Correspondence to Kumud Dhital.

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Dhital, K., Ludhani, P., Scheuer, S. et al. DCD donations and outcomes of heart transplantation: the Australian experience. Indian J Thorac Cardiovasc Surg 36 (Suppl 2), 224–232 (2020). https://doi.org/10.1007/s12055-020-00998-x

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  • DOI: https://doi.org/10.1007/s12055-020-00998-x

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