scholarly journals Comparison of Experimental Rat Models in Donation After Circulatory Death (DCD): in-situ vs. ex-situ Ischemia

2021 ◽  
Vol 7 ◽  
Author(s):  
Maria Arnold ◽  
Natalia Méndez-Carmona ◽  
Rahel K. Wyss ◽  
Anna Joachimbauer ◽  
Daniela Casoni ◽  
...  
Keyword(s):  
Circulatory Arrest ◽  
Ex Situ ◽  
Donation After Circulatory Death ◽  
Cardiac Recovery ◽  
Male Wistar Rats ◽  
Developed Pressure ◽  
Graft Storage ◽  
Contractile Recovery ◽  
Circulatory Death

Introduction: Donation after circulatory death (DCD) could substantially improve donor heart availability. However, warm ischemia prior to procurement is of particular concern for cardiac graft quality. We describe a rat model of DCD with in-situ ischemia in order to characterize the physiologic changes during the withdrawal period before graft procurement, to determine effects of cardioplegic graft storage, and to evaluate the post-ischemic cardiac recovery in comparison with an established ex-situ ischemia model.Methods: Following general anesthesia in male, Wistar rats (404 ± 24 g, n = 25), withdrawal of life-sustaining therapy was simulated by diaphragm transection. Hearts underwent no ischemia or 27 min in-situ ischemia and were explanted. Ex situ, hearts were subjected to a cardioplegic flush and 15 min cold storage or not, and 60 min reperfusion. Cardiac recovery was determined and compared to published results of an entirely ex-situ ischemia model (n = 18).Results: In donors, hearts were subjected to hypoxia and hemodynamic changes, as well as increased levels of circulating catecholamines and free fatty acids prior to circulatory arrest. Post-ischemic contractile recovery was significantly lower in the in-situ ischemia model compared to the ex-situ model, and the addition of cardioplegic storage improved developed pressure-heart rate product, but not cardiac output.Conclusion: The in-situ model provides insight into conditions to which the heart is exposed before procurement. Compared to an entirely ex-situ ischemia model, hearts of the in-situ model demonstrated a lower post-ischemic functional recovery, potentially due to systemic changes prior to ischemia, which are partially abrogated by cardioplegic graft storage.

scholarly journals Cardiac Graft Assessment in the Era of Machine Perfusion: Current and Future Biomarkers

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Martina Bona ◽  
Rahel K. Wyss ◽  
Maria Arnold ◽  
Natalia Méndez‐Carmona ◽  
Maria N. Sanz ◽  
...  
Keyword(s):  
Current Knowledge ◽  
Cellular Damage ◽  
Ex Situ ◽  
Machine Perfusion ◽  
Clinical Protocols ◽  
Donation After Circulatory Death ◽  
Graft Storage ◽  
End Stage ◽  
Circulatory Death ◽  
Cardiac Graft

Abstract Heart transplantation remains the treatment of reference for patients experiencing end‐stage heart failure; unfortunately, graft availability through conventional donation after brain death is insufficient to meet the demand. Use of extended‐criteria donors or donation after circulatory death has emerged to increase organ availability; however, clinical protocols require optimization to limit or prevent damage in hearts possessing greater susceptibility to injury than conventional grafts. The emergence of cardiac ex situ machine perfusion not only facilitates the use of extended‐criteria donor and donation after circulatory death hearts through the avoidance of potentially damaging ischemia during graft storage and transport, it also opens the door to multiple opportunities for more sensitive monitoring of graft quality. With this review, we aim to bring together the current knowledge of biomarkers that hold particular promise for cardiac graft evaluation to improve precision and reliability in the identification of hearts for transplantation, thereby facilitating the safe increase in graft availability. Information about the utility of potential biomarkers was categorized into 5 themes: (1) functional, (2) metabolic, (3) hormone/prohormone, (4) cellular damage/death, and (5) inflammatory markers. Several promising biomarkers are identified, and recommendations for potential improvements to current clinical protocols are provided.

Donation after circulatory death: possible strategies for in-situ organ preservation

2020 ◽  
Vol 86 (9) ◽  
Author(s):  
Marinella Zanierato ◽  
Daniele Dondossola ◽  
Alessandro Palleschi ◽  
Alberto Zanella
Keyword(s):  
Organ Preservation ◽  
Donation After Circulatory Death ◽  
Circulatory Death

scholarly journals Sequential Use of Normothermic Regional and Ex Situ Machine Perfusion in Donation After Circulatory Death Liver Transplant

2020 ◽  
Author(s):  
Davide Ghinolfi ◽  
Daniele Dondossola ◽  
Erion Rreka ◽  
Caterina Lonati ◽  
Daniele Pezzati ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Ex Situ ◽  
Machine Perfusion ◽  
Donation After Circulatory Death ◽  
Circulatory Death

scholarly journals Audit of Ten Years of Donation after Circulatory Death Experience in Queensland: Observations of Agonal Physiology following Withdrawal of Cardiorespiratory Support

2018 ◽  
Vol 46 (4) ◽  
pp. 400-403 ◽  
Author(s):  
D. A. Cook ◽  
N. Widdicombe
Keyword(s):  
Blood Pressure ◽  
Standard Deviation ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
Circulatory Arrest ◽  
Systolic Pressure ◽  
Donation After Circulatory Death ◽  
Arterial Blood ◽  
Death Experience ◽  
Circulatory Death

An audit of ten years’ experience in all patients undergoing withdrawal of cardiorespiratory support (WCRS) in the context of donation after circulatory death (DCD) was conducted in Queensland, Australia (2008 to 2017). One hundred and seventy-one patients proceeded to donation after declaration of death by circulatory criteria with loss of pulsatile arterial blood pressure (circulatory arrest) for five minutes. The demographics, times and haemodynamic observations were abstracted, de-identified and collated. The average age of patients was 43 years (standard deviation 16.1 years) and 63% were male. The median and mean times to an agonal systolic blood pressure below 50 mmHg were 10 and 11 minutes and the median and mean times from WCRS to circulatory arrest were 14 and 16 minutes. After systolic blood pressure fell to 50 mmHg or lower, 33 patients (19.3%) had spontaneous return of systolic pressure to above 50 mmHg. Following periods of circulatory arrest, five patients were documented to have spontaneous return of pulsatile arterial pressure. Two patients had return of circulation after two minutes, but less than five minutes of circulatory arrest and three patients had return of circulation where circulatory arrest had been documented for less than two minutes. Following WCRS, transient restoration of circulation following circulatory arrest may occur, even following two minutes of circulatory asystole, albeit rarely.

In situ lung perfusion is a valuable tool to assess lungs from donation after circulatory death donors category I-II

2013 ◽  
Vol 26 (5) ◽  
pp. 485-492 ◽  
Author(s):  
Caroline Van De Wauwer ◽  
Anita J. Munneke ◽  
Gerwin E. Engels ◽  
Foke M. Berga ◽  
Gerhard Rakhorst ◽  
...  
Keyword(s):  
Lung Perfusion ◽  
Donation After Circulatory Death ◽  
Circulatory Death

scholarly journals Lessons from a pilot for uncontrolled donation after circulatory death in the ED in the UK

2019 ◽  
Vol 37 (3) ◽  
pp. 155-161 ◽  
Author(s):  
Matthew James Reed ◽  
Ian Currie ◽  
John Forsythe ◽  
Irene Young ◽  
John Stirling ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Circulatory Arrest ◽  
Royal Infirmary ◽  
Donation After Circulatory Death ◽  
Pilot Programme ◽  
Lessons Learnt ◽  
Organ Recovery ◽  
The Uk ◽  
Circulatory Death

Worldwide there is a shortage of available organs for patients requiring transplants. However, some countries such as France, Italy and Spain have had greater success by allowing donations from patients with unexpected and unrecoverable circulatory arrest who arrive in the ED. Significant advances in the surgical approach to organ recovery from donation after circulatory death (DCD) led to the establishment of a pilot programme for uncontrolled DCD in the ED of the Royal Infirmary of Edinburgh. This paper describes the programme and discusses the lessons learnt.

Sign in / Sign up

Export Citation Format

Share Document