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History of heart transplantation, the resurgence of DCD heart donations and outcomes following transplantation; the Royal Papworth Experience.

ABSTRACT: Human heart transplantation started more than half a century ago. The Royal Papworth Hospital, in Cambridgeshire, United Kingdom, where this procedure has been performed for more than four decades, has pioneered the resurgence of Donor Circulatory Death (DCD) heart transplantation, acknowledging the fact that the first transplant performed by Dr. Christian Barnard was from a DCD donor. The history of this procedure, the work carried out towards establishing a robust and successful DCD heart transplant program and the outcomes of the first fifty DCD heart transplants are described and discussed.

SUBMITTER: Sudarshan CD

PROVIDER: S-EPMC7324909 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Publications

RETRACTED ARTICLE: History of heart transplantation, the resurgence of DCD heart donations and outcomes following transplantation; the Royal Papworth Experience.

Sudarshan Catherine Dushyanthy CD

Indian journal of thoracic and cardiovascular surgery 20200630 Suppl 2

PMID: 32837040

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Project description:BackgroundHeart transplantation is an effective treatment offering the best recovery in both quality and quantity of life in those affected by refractory, severe heart failure. However, transplantation is limited by donor organ availability. The reintroduction of heart donation after the circulatory determination of death (DCD) in 2014 offered an uplift in transplant activity by 30%. Thoraco-abdominal normothermic regional perfusion (taNRP) enables in-situ reperfusion of the DCD heart. The objective of this paper is to assess the clinical outcomes of DCD donor hearts recovered and transplanted from donors undergoing taNRP.MethodThis was a multicentre retrospective observational study. Outcomes included functional warm ischaemic time, use of mechanical support immediately following transplantation, perioperative and long-term actuarial survival and incidence of acute rejection requiring treatment. 157 taNRP DCD heart transplants, performed between February 2, 2015, and July 29, 2022, have been included from 15 major transplant centres worldwide including the UK, Spain, the USA and Belgium. 673 donations after the neurological determination of death (DBD) heart transplantations from the same centres were used as a comparison group for survival.FindingstaNRP resulted in a 23% increase in heart transplantation activity. Survival was similar in the taNRP group when compared to DBD. 30-day survival was 96.8% ([92.5%-98.6%] 95% CI, n = 156), 1-year survival was 93.2% ([87.7%-96.3%] 95% CI, n = 72) and 5-year survival was 84.3% ([69.6%-92.2%] 95% CI, n = 13).InterpretationOur study suggests that taNRP provides a significant boost to heart transplantation activity. The survival rates of taNRP are comparable to those obtained for DBD transplantation in this study. The similar survival may in part be related to a short warm ischaemic time or through a possible selection bias of younger donors, this being an uncontrolled observational study. Therefore, our study suggests that taNRP offers an effective method of organ preservation and procurement. This early success of the technique warrants further investigation and use.FundingNone of the authors have a financial relationship with a commercial entity that has an interest in the subject.

Project description:Pedestrians are one of the most vulnerable groups at the roadside, furthermore, previous research has demonstrated perceptual-motor limitations in individuals with DCD which may put these individuals at even more at risk in the context of road crossing. However, it is unclear whether this is the lived experience of these individuals at the roadside. Furthermore, difficulties with road crossing and safety have been found in other neurodevelopmental disorders but the impact this might have on an individual with co-occurring difficulties is unknown. Therefore, we utilized a questionnaire to survey the lived experience of adults with DCD and parents of children with DCD with the specific objectives of describing behaviors exhibited by adults and children with DCD (the latter reported by parents) at the roadside and to determine the how these individuals perceive road crossing actions. For each of these we compared different co-occurrence groups. We also had one final objective which was not focused on road crossing but more on the general perception of accidents and unrealistic optimism. Individuals with co-occurrences which have previously been linked to unsafe crossing behaviors (i.e., ADHD, ASD, and LD) reported a greater regularity of dangerous looking behavior (forgetting to look, running without looking) and visibility (crossing between cars, crossing when you can't see), these adults and the parents of these children were seemingly aware of the risky nature of these behaviors. When asked "why" crossing ability might be different, perceptual and motor difficulties alongside heightened awareness of risk and lowered awareness of risk were all cited by participants. Unrealistic optimism was not an explanation for the risky behavior in adults with DCD and in fact, these adults demonstrated a clear understanding of the likelihood of accidents. The findings of this study suggest that road crossing is perceived to be more challenging for both children and adults with DCD and this needs to be taken into account when considering remediation for this group.

Dataset Information

History of heart transplantation, the resurgence of DCD heart donations and outcomes following transplantation; the Royal Papworth Experience.

Publications

RETRACTED ARTICLE: History of heart transplantation, the resurgence of DCD heart donations and outcomes following transplantation; the Royal Papworth Experience.

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