Donation After Circulatory Death Heart Transplant: Current State and Future Directions.

IF 7.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Heart Failure Pub Date : 2024-07-01 Epub Date: 2024-06-20 DOI:10.1161/CIRCHEARTFAILURE.124.011678

Amrin Kharawala, Sanjana Nagraj, Jiyoung Seo, Sumant Pargaonkar, Mayuko Uehara, Daniel J Goldstein, Snehal R Patel, Daniel B Sims, Ulrich P Jorde

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Abstract

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.

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循环死亡心脏移植后的捐献：现状与未来方向。

异位心脏移植是治疗终末期心力衰竭患者的金标准疗法。传统上，心脏移植依靠脑死亡后捐献来实现器官恢复。循环死亡后捐献（DCD）是指在确认循环功能不可逆转地停止后捐献心脏。循环死亡后捐献-异位心脏移植与脑死亡后捐献-异位心脏移植有许多不同之处，这些不同之处对广泛采用循环死亡后捐献-异位心脏移植有影响，其中包括器官恢复、储存方面的差异，以及与循环死亡后捐献-异位心脏移植常温区域灌注有关的伦理考虑。尽管存在这些差异，但 DCD 已显示出良好的早期效果，扩大了捐献者库，使更多人受益于正位心脏移植。本综述旨在介绍 DCD-心脏移植的现状和未来发展轨迹，研究 DCD 与脑死亡后捐献的主要区别，包括临床经验和方法的创新，并探讨围绕 DCD 供体心脏移植新领域的持续伦理挑战。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Heart Failure 医学-心血管系统

CiteScore

12.90

自引率

3.10%

发文量

271

审稿时长

6-12 weeks

期刊介绍： Circulation: Heart Failure focuses on content related to heart failure, mechanical circulatory support, and heart transplant science and medicine. It considers studies conducted in humans or analyses of human data, as well as preclinical studies with direct clinical correlation or relevance. While primarily a clinical journal, it may publish novel basic and preclinical studies that significantly advance the field of heart failure.