2013 - ISODP 2013 Congress


Oral Presentation 5 on DCD Programs 2

12.3 - What is the potential source of heart allografts from Donation after Circulatory Death (DCD) donors?

Presenter: Arjun, Iyer, Darlinghurst, Australia
Authors: Arjun Iyer, Ben Wan, Gayathri Kumarasinghe, Michelle Harkess, Bronwyn Levvey, Greg Snell, Kumud Dhital, Peter Macdonald, Paul Jansz, Emily Granger, Phil Spratt, Allan Glanville


What is the potential source of heart allografts from Donation after Circulatory Death (DCD) donors?

Arjun Iyer2,1, Ben Wan2, Gayathri Kumarasinghe2,1, Michelle Harkess1, Bronwyn Levvey3, Greg Snell3, Kumud Dhital2,1, Peter Macdonald2,1, Paul Jansz1, Emily Granger1, Phil Spratt1, Allan Glanville1

1Heart Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, Australia, 2Heart Transplantation Lab, Victor Chang Cardiac Research Institute, Darlinghurst, Australia, 3Lung Transplant Service, Alfred Hospital, Melbourne, Australia

 

Aim:

Heart Transplantation (Tx) remains the gold standard treatment of ESHF, however is limited by the shortage of donor cardiac allograft availability. Our group has been investigating the viability of hearts from DCD donors, and have demonstrated recovery of hearts post 30 minutes warm ischaemic time (WIT) in pre-clinical studies. In this review, we aim to investigate the potential increase in available heart allografts for Tx from DCD donors.

 

Methods:

We retrospectively reviewed the DCD donor database for Lung Tx across the two highest volume transplant institutions in Australia & New Zealand (St Vincent’s Hospital, Sydney & The Alfred Hospital, Melbourne).  Inclusion criteria were WIT ≤ 30 minutes, donor age <50, and donor inotropes (Noradrenaline (NA)< 0.2 mcg/kg/min), being evaluated between 2007 and 2013.

 

Results:

115 DCD lung donors were reviewed between November 2007 and April 2013. During this period, 38/115 (33%) DCD donors met the criteria of age < 50 & WIT ≤ 30 minutes. This amounts to an additional 7 donors per year, or a 17% increase in donors (38/223 heart Tx at the 2 institutions during this period). Inotrope data was available for St Vincent’s Hospital DCD donors. Incorporating donor NA dose < 0.2 mcg/kg/min, there were 11/39 DCD donors suitable for heart donation. At this institution, this amounts to an additional 9% (11/122) of donors for cardiac Tx.

 

Conclusion:

Based on this review of the data, viable cardiac allografts from DCD donors may allow an increase in heart Tx by up to 17%, a significant increase especially considering the 10% mortality on the waiting list. This review was limited to DCD accepted lung donors, therefore likely to be underestimating the potential – evaluation of the entire (all organs) DCD pool is underway to gauge the true potential.


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