Successful Recovery of Cardiac Function Following 20 min of a No-touch Period in a Donation After Circulatory Death: A Case Report

Paolo Zanatta; Federico Linassi; Nicola Gasparetto; Luigi Polesello; Matteo Bussola; Ennio Nascimben; Giuseppe Minniti; Carlo Cernetti; Matteo Angelini; Giuseppe Feltrin; Maurizio Romano; Giacomo Zanus; Francesco Benazzi; Gino Gerosa

doi:10.1097/TP.0000000000004940

Successful Recovery of Cardiac Function Following 20 min of a No-touch Period in a Donation After Circulatory Death: A Case Report

Transplantation. 2024 May 16. doi: 10.1097/TP.0000000000004940. Online ahead of print.

Authors

Affiliations

¹ Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy.
² Department of Pharmaceutical and Pharmacological Sciences, Università degli Studi di Padova, Padova, Italy.
³ Division of Cardiology, Neuro-Cardio-Vascular Department, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy.
⁴ Division of Cardiac Surgery, Neuro-Cardio-Vascular Department, Treviso Regional Hospital AULSS 2 Marca Trevigiana Piazzale Ospedale 1, Treviso, Italy.
⁵ Veneto Region Transplant Center Coordination, Veneto Region, Italy.
⁶ Division of Hepato-Pancreatic and Kidney Transplantation Surgery, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy.
⁷ Department of Hospital Strategic Direction, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy.
⁸ Cardiac Surgery Clinic, Department of Cardiac, Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy.

PMID: 38750639
DOI: 10.1097/TP.0000000000004940

Abstract

Background: Withdrawal of life-sustaining therapy (WLST) performed in the circulatory determination of death (DCD) donors leads to cardiac arrest, challenging the utilization of the myocardium for transplantation. The rapid initiation of normothermic regional perfusion or extracorporeal membrane oxygenation after death helps to optimize organs before implantation. However, additional strategies to mitigate the effects of stress response during WLST, hypoxic/ischemic injury, and reperfusion injury are required to allow myocardium recovery.

Methods: To this aim, our team routinely used a preconditioning protocol for each DCD donation before and during the WLST and after normothermic regional perfusion/extracorporeal membrane oxygenation. The protocol includes pharmacological treatments combined to reduce oxidative stress (melatonin, N-acetylcysteine, and ascorbic acid), improve microcirculation (statins), and mitigate organ's ischemic injury (steroids) and organ ischemia/reperfusion injury (remifentanil and sevoflurane when the heart is available for transplantation).

Results: This report presents the first case of recovery of cardiac function, with the only support of normothermic regional reperfusion, following 20 min of a no-touch period and 41 min of functional warm ischemic time in a DCD donor after the preconditioning protocol.

Conclusions: Our protocol seems to be effective in abolishing the stress response during WLST and, on the other hand, particularly organ protective (and heart protective), giving a chance to donate organs less impaired from ischemia/reperfusion injury.