Ex Situ Perfusion of Hearts Donated After Euthanasia: A Promising Contribution to Heart Transplantation

Vincent van Suylen; Eline M Bunnik; Johanna A M Hagenaars; Imran A Ertugrul; Jan A M Bollen; Massimo A Mariani; Michiel E Erasmus

doi:10.1097/TXD.0000000000001120

Ex Situ Perfusion of Hearts Donated After Euthanasia: A Promising Contribution to Heart Transplantation

Transplant Direct. 2021 Feb 22;7(3):e676. doi: 10.1097/TXD.0000000000001120. eCollection 2021 Mar.

Authors

Vincent van Suylen¹, Eline M Bunnik², Johanna A M Hagenaars³, Imran A Ertugrul¹, Jan A M Bollen⁴, Massimo A Mariani¹, Michiel E Erasmus¹

Affiliations

¹ Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
² Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
³ Department of Surgery, Donation and Transplant Coordination, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁴ Department of Anesthesiology, Radboud UMC, University Medical Center Nijmegen, Nijmegen, The Netherlands.

Abstract

Organ donation after euthanasia is performed in an increasing number of countries. In this donation after circulatory death procedure, it has not been possible to donate the heart. Recent literature, however, reports positive results of heart donation after circulatory death. Therefore, patients who donate organs following euthanasia might be suitable candidates for heart donation. We want to confirm this assumption by sharing the results of 2 cases of heart donation following euthanasia with ex situ subnormothermic heart preservation. Our aim is to raise awareness of the potential of heart donation following euthanasia for both clinical transplantation and research.

Methods: The data of 2 consecutive heart donations following euthanasia were collected prospectively. Informed consent was obtained from the patients themselves for heart donation for research purposes. An acellular oxygenated subnormothermic machine perfusion strategy was used to preserve both donor hearts. Subsequently, the hearts were evaluated on a normothermic perfusion machine using a balloon in the left ventricle.

Results: Heart donation following euthanasia was feasible without significant changes in existing retrieval protocols. Duration of machine perfusion preservation was 408 and 432 minutes, for heart 1 and 2, respectively. For heart 1, developed pressure (P_dev) was 119 mm Hg, maximal rate of pressure rise (dP/dt_max), and fall (dP/dt_min) were 1524 mm Hg/s and -1057 mm Hg/s, respectively. For heart 2, P_dev was 142 mm Hg, dP/dt_max was 1098 mm Hg/s, and dP/dt_min was -802 mm Hg/s.

Conclusions: Hearts donated following euthanasia are highly valuable for research purposes and can have sufficient quality to be transplanted. With the implementation of ex situ heart perfusion, patients who are to donate their organs following euthanasia should also be able to donate their hearts. The complex combination of euthanasia and heart donation is ethically sound and surgically feasible and can contribute to shortening the heart transplant waiting list.