Against Odds of Prolonged Warm Ischemia: Early Experience With DCD Heart Transplantation After 20-Minute No-Touch Period
Gino Gerosa, Giovanni Battista Luciani, Nicola Pradegan, Vincenzo Tarzia, Tea Lena, Paolo Zanatta, Demetrio Pittarello, Francesco Onorati, Antonella Galeone, Leonardo Gottin, Massimo Boffini, Marinella Zanierato, Matteo Marro, Sofia Martìn Suàrez, Luca Botta, Paola Lilla Della Monica, Mariano Feccia, Guido Maria Olivieri, Amedeo Terzi, A. Oliveti, Giuseppe Feltrin, Massimo Cardillo, Claudio Russo, Davide Pacini, Mauro Rinaldi
Abstract
Heart transplantation (HT) with grafts obtained by controlled donation after circulatory death (cDCD) has shown promising clinical results, with early and mid-term outcomes similar to donation after brain death (DBD) [1-2]. However, cDCD-HT success (both with direct organ procurement and thoraco-abdominal normothermic regional perfusion –taNRP–) has been demonstrated in countries with short asystolic ‘no-touch’ periods (e.g. five minutes for England or two minutes for Australia). Italy has one of the longest known no-touch periods for circulatory death declaration (twenty minutes), and this has been considered a major limiting factor for successful cDCD-HT. Nevertheless, cDCD- HT in Italy was approved in April 2023. Following approval from the Italian Regulatory Authority, the first cDCD-HT was performed in Padova on May 11th, 2023 [3].