About this Research Topic
Heart failure is one of the leading causes of morbidity and mortality in western countries and recent estimates indicate that 5-10% of patients with heart failure have advanced disease. In these cases, morbidity and mortality are very high and quality of life is very poor. Heart transplantation remains the only therapeutic option, but unfortunately, the disparity between the number of potential recipients and donors is worsening. Indeed, in spite of great efforts, the number of cardiac grafts from donors after brain death (DBD) does not compensate for the rapidly increasing number of candidates for heart transplantation. The use of hearts from donors after circulatory death (DCD) could possibly be a solution.
DCD has received much attention in recent years as a valuable source of donor organs for kidney, liver, pancreas and lung transplantation; however, concerns regarding susceptibility of the heart to warm ischemic injury have led to reluctance toward the use of DCD cardiac grafts. It has been estimated that with the use of DCD organs, cardiac graft availability would be substantially increased. Furthermore, the feasibility of this approach has been recently confimed in clinical practice. For example, three successful heart transplantations in infants using DCD were reported 8 years ago, and within the last two years, a total of 17 adult DCD heart transplantations have been performed in Australia and the UK. This encouraging progress demonstrates an enormous potential for cardiac grafts procured with DCD.
Given the expected improvements in patient outcomes, the DCD approach clearly merits further investigation and development. However the success of DCD for in heart transplantation most certainly depends on radical changes in the way donnors and organs are processed. Among others, evidence-based clinically applicable approaches that permit rapid graft evaluation are needed; the development of optimal post-transplant reperfusion strategies is necessary; ethical, political, cultural and psychological aspects of DCD heart transplantation must be addressed. The integration of these multiple aspects, as well as the consolidation of optimal technical and logistic approaches, are paramount both for attaining the best possible patient outcomes and for enabling widespread adherence to this practice in clinical medicine.
With the current Frontiers Topic, we aim to explore and discuss scientific, clinical and ethical aspects related to DCD heart transplantation, in order to to promote coherent and efficient strategies towards the optimization of patient benefits.
Keywords: donation after circulatory death (DCD), DCD heart transplantation, local in situ DCD organ perfusion, ex vivo cardiac graft perfusion, cardiac graft conditioning and preservation, organ procurement with DCD, DCD donor selection, DCD donor treatment, DCD cardiac graft evaluation, ethics in DCD, clinical advances with DCD heart transplantation
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