title: Functional evaluation of human donation after cardiac death donor hearts using a continuous isolated myocardial perfusion technique: Potential for expansion of the cardiac donor population.
abstract: OBJECTIVE
  To investigate the resuscitation potential and contractile function in adult human donation after cardiac death (DCD) hearts by ex vivo perfusion.
  
  
  METHODS
  With institutional review board approval and under the DCD protocol at the University of Wisconsin (UW) Organ Procurement Organization, 5 brain dead (BD) and 5 DCD donor hearts were evaluated. All BD hearts were declined for clinical transplantation because of coronary artery disease, advanced age, or social history. All hearts were preserved by flushing and cold storage with UW solution. By using our ex vivo perfusion system, the left ventricular end systolic pressure-volume relationship (LV-ESPVR) was assessed for 2 hours of oxygenated blood reperfusion.
  
  
  RESULTS
  All BD (n = 5) and 4 DCD hearts were successfully resuscitated. One DCD heart was unable to be resuscitated due to prolonged warm ischemic time (WIT; 174 minutes). Mean WIT for resuscitated DCD hearts (from extubation to flushing with cold UW solution) was 34 ± 3 minutes (range, 26 to 40 minutes); mean cold ischemic time for BD donors was 211 ± 31 minutes compared with 177 ± 64 minutes for DCD donors. The calculated LV-ESPVRs for BD hearts after 1 and 2 hours of reperfusion were 6.9 ± 0.7 and 5.7 ± 1.0 mm Hg/mL, respectively; LV-ESPVRs for DCD hearts after 1 and 2 hours of reperfusion were 5.6 ± 1.5 (P = .45) and 3.0 ± 0.7 mm Hg/mL (P = .07), respectively.
  
  
  CONCLUSIONS
  We successfully resuscitated and measured ex vivo cardiac function in human DCD and BD donor hearts. Resuscitation potential in DCD hearts was achieved when the WIT was less than 40 minutes. Contractile performance in DCD hearts tended to be lower compared with BD hearts. Further investigation with longer reperfusion periods seems warranted.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis. Electronic address: osaki@surgery.wisc.edu.
authors.forename: Satoru
authors.initials: S
authors.lastname: Osaki
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Locher
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Entela B
authors.initials: EB
authors.lastname: Lushaj
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Shahab A
authors.initials: SA
authors.lastname: Akhter
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Takushi
authors.initials: T
authors.lastname: Kohmoto
mesh_terms: D000241:Adenosine / Q000009:adverse effects / Q000494:pharmacology; D000328:Adult; D000493:Allopurinol / Q000009:adverse effects / Q000494:pharmacology; D001926:Brain Death; D050377:Cold Ischemia; D005260:Female; D005978:Glutathione / Q000009:adverse effects / Q000494:pharmacology; D006331:Heart Diseases / Q000401:mortality*; D016027:Heart Transplantation; D006801:Humans; D007328:Insulin / Q000009:adverse effects / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D019188:Organ Preservation Solutions / Q000009:adverse effects / Q000494:pharmacology*; D010477:Perfusion / Q000009:adverse effects / Q000379:methods*; D011887:Raffinose / Q000009:adverse effects / Q000494:pharmacology; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D016277:Ventricular Function, Left; D017725:Ventricular Pressure; D052096:Warm Ischemia; D014922:Wisconsin
chemical_list: D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose