Heart transplantation remains the gold standard therapeutic option for improving quality of life and survival for patients with advanced heart failure, currently one of the leading causes of morbidity and mortality in western countries. Unfortunately, graft availability through conventional donation after brain death is insufficient to meet the need for all patients requiring this life-saving intervention.
Use of donation after circulatory death (DCD), as an additional source of donor hearts, has emerged as a solution to increase organ availability. However, due to conditions surrounding death of the donors, this pool of hearts is subjected to a period of warm, global ischemia before procurement, which is a major concern for graft quality. Despite these concerns, heart transplantation with DCD has been demonstrated as feasible and since 2015, more than 150 successful transplantations have been performed worldwide. Survival data up to 5-years post-transplantation is available and outcomes appear to be comparable to conventional heart donation after brain death. Since the feasibility of DCD heart transplantation has been demonstrated, identification and optimization of clinical protocols are required in order to fully utilize the potential of this donor population. Importantly, identification of reliable means to assess graft quality before transplantation are critical, not only to ensure the generalized adoption of DCD heart transplantation in a safe and effective manner, but also to permit the development and application of effective protective treatment strategies for cardiac grafts. In addition, optimal approaches for limiting, reducing, or even preventing cardiac graft damage from warm ischemia and subsequent reperfusion, also termed cardioprotection, remain to be established. These specific areas of preclinical research are being investigated in the Longnus Lab.