Experiencia en DAC cardiaca en la Comunidad Valenciana: programa de extracción cardiaca extrahospitalaria

Introduction

In Spain, since 2020, hearts obtained from donation after circulatory determination of death (DCD) have been used for heart transplants. We show our experience from the beginning of the heart DCDs program. An out-of-hospital cardiac extraction protocol has been implemented within the Valencian Community.

Materials and method

From November 2022 to April 2024, 21 cardiac assessments have been performed in the context of DCD.

Donor inclusion criteria: donor < 55 years old; family donation consent; functional warm ischemia time < 30 min.

Donor exclusion criteria, additional to those of a cardiac donation: adrenaline infusion; dobutamine infusion; norepinephrine infusion > 0,3 μg/kg/min.

This is a retrospective descriptive study.

Results

Of the 21 possible donors, 19 were valid hearts, 2 of them were for a hospital outside the community. The mean age of the donors was 40.4 years, most of them men. In total, 17 patients were transplanted in our hospital. The mean cardiac ischemia time was 136.41 min. Primary graft failure was described in 8 patients.

Conclusions

The cardiopulmonary bypass allowed continuous monitoring of aerobic and anaerobic metabolism, correct emptying of the cardiac chambers and the administration of cardioplegia with pressure, temperature and flow control.

Our experience highlights the possibilities of success with hearts obtained from a DCD, representing an increase in the number of donors and a decrease in the waiting time for the transplant.