Heart transplant from a dead donor could change the lives of patients waiting for organs
Even though India has the largest population in the world, the ratio of organ donation stands at less than one donation per million population.
Whether it is because of a lack of information or the fear of consequences, but many people are still reluctant to donate organs. This leads to an extreme shortage of organ donations. Many patients who have end-stage organ failure die because of not getting the organs.
In August 2019, Dr Vasanthi Ramesh, the Director of National Organ Tissue Transplant Organisation (NOTTO), told ANI that even though India has the largest population in the world, the ratio of organ donation stands at less than one donation per million population. The organ donation ratio for Spain stood at 50 donations per million population.
Well, how amazed would you be if we told you that organs could be received from the dead people and transplanted to the needy ones? With the help of a procedure called “Donation after Circulatory Death” (DCD), doctors have been able to revive the heart of a deceased donor and transplant it into a recipient.
Back from the dead
Donation after Circulatory Death (DCD) is a process of harvesting organs from a person who has been declared dead and using them for patients who need organs due to any kind of organ failure.
In 2015, the doctors of the Royal Papworth Hospital, England, successfully performed Europe’s first heart transplant using a DCD donor’s heart. A total of 75 DCD transplants have been performed at the Royal Papworth since the trial began four years ago.
Recently, on 2nd December 2019, doctors at the Duke University, North Carolina, performed US’s first DCD transplant successfully.
The non-heart-beating donors
A person is considered as a DCD donor only after circulatory arrest, i.e., absence of heart sounds, pulse, blood pressure, breathing and no neurological function (no brain activity).
DCD donors, also frequently referred to as non-heart-beating donors, are classified in four categories by the World Health Organisation (WHO).
Category I: Dead on arrival - Person was dead on arrival to the hospital.
Category II: Unsuccessful resuscitation - Patient could not be revived after all the possible measures.
Category III: Awaiting cardiac arrest - Patients for whom circulatory death occurs after a planned withdrawal of life‐sustaining therapies.
Category IV: Cardiac arrest in the brain-dead donor - Patient whose heart is functional but the brain isn’t.
Harvesting the organs
In the case of every DCD donor a ‘Dead Donor Rule’ is followed which says that the donor must be declared dead before organ removal rather than dying as a result of the donation.
Along with that, in all DCD protocols, a strict interval is respected between the circulatory arrest and the declaration of death. This interval is called the ‘no-touch’ period which varies between 2-10 min.
After the declaration of death, the donor needs to be connected to a cardiopulmonary bypass system by putting up an intravenous needle in the femoral artery to preserve the abdominal organs. This allows the doctors to proceed with organ harvesting by hypothermic machine perfusion.
Hypothermic machine perfusion is a dynamic cold preservation method at 4°C which ensures a continuous supply of metabolic substrates (substances used to produce energy) to the donated organ till the time it doesn’t enter the recipient’s body. This keeps the organ preserved and viable.
Hypothermic machine perfusion, when compared to nonheart-beating donors, is considered to be one of the better ways to keep the donor heart viable.
The bright future
With the success of DCD, there is a hope that it would increase the number of donations, which would ultimately decrease the waiting time for the many patients who have been waiting for an organ.
Further research and clinical trials are being planned to enhance the outcomes for the betterment of people with organ failure.
For more information, please read our article on Heart Failure.
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