Donation After Cardiac Death Heart Transplantation in America Is Clinically Necessary and Ethically Justified
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Many patients die on American transplant waiting lists because there are far fewer hearts donated after brain death than patients who would benefit from transplantation. For this reason, extended criteria donation after brain death hearts, which would otherwise be considered inferior, are routinely transplanted. Examples for extended criteria donation after brain death hearts include older donors, from further distances, with lower cardiac function, and higher risk features, such as hepatitis C. In response to the dire need for donor hearts, a small number of transplant centers in Australia and Europe have pushed the envelope further still by pioneering heart transplantation following donation after cardiac death (DCD).1 Death of DCD donors is declared on the basis of irreversible cardiac arrest rather than irreversible loss of all functions of the entire brain.2 However, because of unique ethical and legal concerns that arise from the surgical techniques for DCD heart procurement, there are no clinically active DCD heart transplantation programs in America.
History of DCD Heart Transplantation
The first human heart transplant, performed by Christiaan Barnard in 1967, was made possible by a DCD donor and a recipient who was located in an operating room adjacent to the donor.3 This seminal medical achievement was marred in ethical controversy, which led to the Harvard criteria for brain death in 1968.4 DCD heart transplantation was subsequently abandoned in favor of donation after brain death heart transplantation because DCD hearts were considered inferior out of concern for ischemic injury to the donor heart.
Interest in DCD heart …