OPPORTUNITIES FOR USING CARDIAC ALLOGRAFTS AFTER CIRCULATORY DEATH

Highlights

• Donation after Circulatory Death (DCD) represents a strategically significant avenue for overcoming the critical shortage of donor hearts, as it allows for a substantial expansion of the donor pool beyond traditional donation after brain death.
• The key technological approaches enabling the clinical implementation of DCD heart transplantation are normothermic regional perfusion (NRP) in situ and ex-vivo machine perfusion (e.g., the OCS system), both aimed at minimizing ischemic damage to the graft.
• Implementing DCD programs in Russia requires addressing a complex set of medical, ethical, and legal issues, including the optimization of legislation, standardization of protocols, and training of multidisciplinary teams, drawing on successful international experience.

Abstract

The critical shortage of donor hearts in the Russian Federation necessitates innovative solutions. Donation after Circulatory Death (DCD) offers significant potential to expand the donor pool beyond traditional donation after brain death. Implementing DCD heart programs in Russia faces complex medical, legal, and logistical barriers. Key challenges include the narrow window for organ recovery, the risk of myocardial ischemic injury, the need to refine protocols for death determination, and addressing ethical concerns. Nevertheless, international experience demonstrates successful DCD heart transplantation utilizing advanced organ preservation technologies (e.g., perfusion systems). Developing DCD in Russia requires optimizing legislation, establishing specialized protocols, training multidisciplinary teams, and enhancing public awareness. Implementing DCD could substantially alleviate the organ shortage and reduce waitlist mortality.

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