Does The Assessment Of Dcd Donor Hearts On The Organ Care System Using Lactate Need Redefining?

Distant procurement of hearts donated after circulatory determined death (DCD) has relied on machine perfusion with the Organ Care System (OCS) (TransMedics, USA). Assessment during OCS perfusion is based on lactate profiles together with aortic pressure and flow. Current practice is based on prior experience of donation after brain death (DBD) hearts with a positive arterio-venous (A-V) lactate differential, a reducing trend and a final lactate concentration of < 5mmol/L. However these may not be directly applicable to DCD hearts.