Fall 2020 Chimera

2020: Year of DCD

This year has seen progress on multiple fronts in donation after circulatory death (DCD) transplantation. As reported in JAMA in January 2020, this year heralded the first adult DCD heart transplant in the United States. This transplant, performed at Duke University Hospital, was part of a larger, randomized, multi-center TransMedics clinical trial that is currently underway. According to the study’s authors, DCD heart transplantation has the potential to expand the donor pool up to 30%.

This year also saw the Toronto Lung Transplant Program report on their initial experience of 5 successful uncontrolled DCD lung transplants, the first series in North America. In this feasibility study in the American Journal of Transplantation, the authors report on the safety and simplicity of recovering lungs from uncontrolled DCDs. Both of the aforementioned heart and lung studies took advantage of the emerging technology of ex vivo perfusion or normothermic machine perfusion. This technology may facilitate increased DCD organ utilization by ameliorating cold ischemic injury and by allowing for the assessment of organ viability prior to transplantation.

Finally, in an effort to develop new national best practices in liver DCD recovery, the American Society of Transplant Surgeons (ASTS) and the Association of Organ Procurement Organizations (AOPO) surveyed liver transplant surgeons and OPO leadership. This survey data in combination with literature review and the ASTS DCD Task Force expert opinion led to the formation of proposed ASTS/AOPO DCD recovery best practices guidelines that were published in Clinical Transplantation in July 2020. These recommendations aim to standardize DCD liver recovery practices in an effort to optimize organ utilization.