Transplante Cardiaco con donantes cadavéricos: de la investigación a la práctica clínica;
Heart Transplantation Using Donors after Circulatory Death: From Research to Clinical Practice

Los donantes cadavericos para trasplante cardiacos se abandonaron desde la decada de 1970 con el advenimiento de la ley  de muerte cerebral ( cadaveres con corazon latiendo), en los cuales el Corazon se halla latiendo y perfundido hasta ultimo momento previo al explante. Pero la escasez de donantes ha reavivado el interes en la investigacion animal y clinica para utilizar donantes cadavericos para trasplante cardiaco, intentando optimizar la funcion cardiaca luego del period de deprivacion de oxigeno producido por la hipotension severa y posteriormente la detencion circulatoria.  Papworth Hospital ha realizado una investigacion clinica exitosa, efectuando ocho trasplantes cardiacos con donantes cadavericos sin mortalidad, y es el lider mundial en esta practica al momento. Se eligieron  recipientes de bajo riesgo,con consentimiento previo expreso.  Los donantes cadavericos fueron reperfundidos con el uso de dispositivo de circulacion extracorporea, y luego de ser destetados del apoyo circulatorio, el Corazon fue explantado y conectado  a la maquina de perfusion para ser trasladados y a la vez evaluados funcionalmente y luego implantados.

Donation after circulatory death for heart transplantation was abandoned in the 1970s with the advent of the brain death law (donation after brain death), where the donor heart is beating and perfused up to the moment prior to organ retrieval. Shortage of donors has renewed the interest in animal and clinical research of donors after circulatory death for heart transplantation, aiming at optimizing heart function after the period of oxygen deprivation caused by severe hypotension and subsequent circulatory arrest. This study presents the initial experience with donation after circulatory death for heart transplantation at our institution. Papworth Hospital has performed a successful clinical investigation in which ten cardiac transplants were performed with hearts from donation after circulatory death, without mortality. Low risk recipients who had previously signed their consent were chosen. Most hearts from donation after circulatory death were reperfused with an extracorporeal circulation device, and following weaning from the circulatory support the heart was harvested and connected to the perfusion machine for transportation and simultaneous assessment of function before implantation. In conclusion, this technique could be used for cardiac transplantation with satisfactory outcomes.