AI Article Synopsis
- Heart transplantation is essential for treating severe heart failure, but there's a shortage of donor hearts, making it crucial to expand the donor pool, particularly by using hearts from circulatory death donations.
- A systematic review was conducted of studies focusing on heart transplantations after circulatory death, analyzing both clinical and preclinical research, while excluding studies related to children or other organs.
- The review highlights promising techniques and research aimed at improving organ performance and ethical considerations that need to be addressed before widely adopting this method for increasing the donor heart supply.
Article Abstract
Introduction: Heart transplantation is the treatment of choice for end-stage heart failure. There is a mismatch between the number of donor hearts available and the number of patients awaiting transplantation. Expanding the donor pool is critically important. The use of hearts donated following circulatory death is one approach to increasing the number of available donor hearts.
Materials And Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines utilizing Pubmed/MEDLINE and Embase. Articles including adult human studies and preclinical animal studies of heart transplantation following donation after circulatory death were included. Studies of pediatric populations or including organs other than heart were excluded.
Results: Clinical experience and preclinical studies are reviewed. Clinical experience with direct procurement, normothermic regional perfusion, and machine perfusion are included. Preclinical studies addressing organ function assessment and enhancement of performance of marginal organs through preischemic, procurement, preservation, and reperfusion maneuvers are included. Articles addressing the ethical considerations of thoracic transplantation following circulatory death are also reviewed.
Conclusions: Heart transplantation utilizing organs procured following circulatory death is a promising method to increase the donor pool and offer life-saving transplantation to patients on the waitlist living with end-stage heart failure. There is robust ongoing preclinical and clinical research to optimize this technique and improve organ yield. There are also ongoing ethical considerations that must be addressed by consensus before wide adoption of this approach.
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| http://dx.doi.org/10.1016/j.jss.2023.07.050 | DOI Listing |
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