Donation after circulatory death (DCD) offers a potential additional source of cardiac allografts. We used a porcine asphyxia model to evaluate viability of DCD hearts subjected to warm ischemic times (WIT) of 20–40 min prior to flushing with Celsior (C) solution. We then assessed potential benefits of supplementing C with erythropoietin, glyceryl trinitrate and zoniporide (Cs), a combination that we have shown previously to activate ischemic postconditioning pathways. Hearts flushed with C/Cs were assessed for functional, biochemical and metabolic recovery on an ex vivo working heart apparatus. Hearts exposed to 20-min WIT showed full recovery of functional and metabolic profiles compared with control hearts (no WIT). Hearts subjected to 30- or 40-min WIT prior to C solution showed partial and no recovery, respectively. Hearts exposed to 30-min WIT and Cs solution displayed complete recovery, while hearts exposed to 40-min WIT and Cs solution demonstrated partial recovery. We conclude that DCD hearts flushed with C solution demonstrate complete recovery up to 20-min WIT after which there is rapid loss of viability. Cs extends the limit of WIT tolerability to 30 min. DCD hearts with ≤30-min WIT may be suitable for transplantation and warrant assessment in a transplant model.

Introduction: Utilising pharmacological ischaemic post-conditioning strategies, we have demonstrated excellent cardiac functional recovery in DCD hearts following 30 min warm ischaemia time (WIT) [ [1] Cardiac Transplantation using hearts from Donation after Circulatory Death (DCD) Donors—a viable source of organs? Submitted abstract 65 ANZSCTS Annual Scientific Meeting 2012. Google Scholar ]. This has been validated on an ex-vivo construct in the laboratory. The aim of this study was to assess recovery of DCD hearts in a clinically approved Organ Care System – Transmedics OCS. This ex-vivo perfusion device allows assessment of marginal organs from brain dead donors prior to transplantation (Tx). We hypothesised that the Transmedics OCS would provide a suitable platform to gauge the viability of DCD hearts.