Donor Heart Procurement From the Donation after Circulatory Death Pathway

Until recently, only isolated cases of cardiac transplantation utilizing hearts procured from the donation after circulatory death pathway, between co-located donor and recipient, have been reported. The strategy of utilizing supplemented cardioplegia in conjunction with a rapid surgical protocol to reduce warm ischemia, combined with subsequent donor heart evaluation on a portable ex-situ perfusion system, has permitted the use of these extended-criteria organs for successful clinical orthotopic cardiac transplantation in a reliable and reproducible manner. We describe the technique developed and used at St Vincent's Hospital in Sydney, Australia, for distantly procured donation after circulatory death hearts.