TRANSPLANTATIONThe American Association for Thoracic Surgery 2023Expert Consensus Document:Adult cardiactransplantation utilizing donors after circulatory deathJacob N.Schroder,MD,"Sarah Scheuer,MD,PhD,Pedro Catarino,MD,Arthur Caplan,PhD,Scott C.Silvestry,MD,Valluvan Jeevanandam,MD,'Stephen Large,MD,PhD,Ashish Shah,MD,Peter MacDonald,MD,Mark S.Slaughter,MD,'Yoshifumi Naka,MD,PhD,andCarmelo A.Milano,MDOrgan donation can take place after patient death,which is→0medically and legally defined in 1 of 2 manners:(1)irre-versible cessation of all brain function or (2)pemmanent4cessation of circulation.Brain death is conventionally es-tablished by repeated neurological examinations demon-strating the absence of brain stem reflexes or absence ofbrain perfusion.Circulatory death is defined by the absenceof a pulse detemmined by physical examination or by intra-arterial pressure monitoring.The first cardiac transplanta-+-司tion was performed in 1967 by Christiaan Barnard inCommon algorithm for DCD heart transplant case.Cape Town,South Africa.Although this first transplantwas performed using a DCD donor,after establishment ofbrain death criteria,the use of DCD hearts ceased becauseCENTRAL MESSAGEof the concerns regarding ischemic injury associated withAdult heart transplantation using☒circulatory death.Until recently,adult cardiac transplanta-DCD was restarted in 2014.Sincetion has entirely used "heart beating"donation after braindeath (DBD)donors.In this article,we describe recent re-then,there has been increasingnewed application of DCD for cardiac transplantation,use of DCD for heart transplanta-focusing on what has been learned and what areas warranttion;early outcomes are equal tofurther investigation.The United States accounts for approximately half of thethose achieved with DBD donors.overall world heart transplant volume.?Heart transplantvolume in the United States using DBD donors has progres-PERSPECTIVEsively increased over the last 5 years.This is partly due toThe results of this trial,reported in 2022,supportthe finding of equivalent earty survival with thethe increased use of advanced age,hepatitis C positive,oruse of DCD versus DBD donors.Examination ofotherwise marginal donors.In addition,the increased num-centers that have engaged in DCD for cardiacber of heart transplants may result from greater availabilitytransplantation suggests that the use of DCD do-of donors who die related to drug overdose.Likewise,thenors could significantly increase overall volume.world heart transplant volume appears to be increasing pre-These developments offer hope that the use ofdominantly due to DBD donors.The Global Observatorydonation after circulatory death (DCD)mayon Donation and Transplantation reports 8722 transplantsgreatly narrow the gap between the populationperformed worldwide in 2019,a 5%increase in totalof patients in need and the donor poolnumbers versus 2018.Waitlist mortality in the UnitedSee Commentary on page XXX.States has progressively decreas
