Cardiac Recovery in a Human Non–Heart-beating Donor After Extracorporeal Perfusion: Source for Human Heart Donation? Ayyaz Ali, MRCS, a Paul White, PhD, b Kumud Dhital, FRCS, a Marian Ryan, RGN, a Steven Tsui, FRCS, a and Stephen Large, FRCP, FRCS a Successful renal, liver and more recently lung transplantation using organs from non– heart-beating donors (NHBDs) has been reported. Regarding the heart, it has generally been assumed that warm ischemic insult would result in overwhelming and irreversible myocardial damage. We report recovery of cardiac function in a human NHBD by using extracorporeal perfusion 23 minutes after cardiorespiratory arrest. Successful cardiac resuscitation in the NHBD represents a potential source of increased donor organ supply for clinical heart transplantation. J Heart Lung Transplant 2009;28:290 –3. Copyright © 2009 by the International Society for Heart and Lung Transplantation. Cardiac transplantation is the definitive treatment for end-stage heart failure. Unfortunately, a progressive decline in the number of suitable donor organs has limited activity worldwide. 1 Over the past decade, there has been a progressive increase in the number of organs procured from non– heart-beating donors (NHBDs). 2–5 In the UK, the number of transplants using organs from NHBDs increased by 44% in 2007. 6 It is estimated that there are approximately 1,200 NHBDs annually in the UK. NHBDs undergo a cardiac arrest either in controlled or uncontrolled circumstances as categorized by the Maastrict classification. 7 The dura- tion of warm ischemia associated with cardiac arrest in an uncontrolled environment (Maastricht Categories I and II) limits the use of these organs. In the setting of controlled cardiac arrest, after withdrawal of supportive therapy (Maastricht Categories III and IV), access to the donor is allowed after a mandatory “stand-off” period during which death is confirmed. Renal, hepatic and more recently lung transplantation has been performed success- fully using organs from NHBDs. 8 –13 With regard to cardiac donation it has generally been considered that warm ischemia, with a possible contribution of anoxic neuro- logic injury, would lead to irreversible myocardial damage. We report successful resuscitation of a human NHBD heart with functional recovery after rapid establishment of extracorporeal circulation in the donor. CASE REPORT A 57-year-old woman presented to the local hospital with sudden onset of headache. Her past medical history was limited to treated hypothyroidism. Her condition deterio- rated and she developed right-sided hemiparesis and homononymous heminopia. A computerized tomography (CT) scan of her brain demonstrated a large intracranial bleed in the left parietal region, after which she was transferred to the regional neurosurgical unit. On arrival, she was unconscious with a Glasgow Coma Scale (GCS) score of 3. The patient was subsequently intubated and mechanically ventilated. She was hemodynamically stable without inotropic support and had normal renal and respiratory parameters. Her neurologic status was irrecov- erable and, after discussion between her intensive-care physicians and immediate family, it was decided to with- draw therapy. She was a suitable candidate for non– heart- beating organ donation and informed consent was ob- tained by the local transplant coordinator for organ donation and research relating to cardiac resuscitation. The study was previously approved by our local research ethics committee. Mechanical ventilation was discontinued. The donor was extubated at 3:30 p.m. and became asystolic 1 minute later. A 5-minute stand-off period was observed to ensure the absence of any electrical cardiac activity, allowing confirmation of death. After this period elapsed, the donor was promptly transferred to the operating theater where the surgical teams were scrubbed and ready. The donor arrived into the oper- ating theater at 3:47 p.m. and was transferred to the operating table. A median sternotomy incision was made at 3:50 p.m., the pericardium was opened, and the heart and great vessels exposed. On inspection, the heart was asystolic and moderately distended. A long From the a Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge; and b Department of Medical Physics and Clinical Engineering, Addenbrooke’s Hospital, Cambridge, UK. Submitted May 20, 2008; revised September 14, 2008; accepted December 1, 2008. Reprint requests: Ayyaz Ali, MD, Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, 10 Sandringham Drive, Cambridge CB3 8RE, UK. Telephone: 650-669-5776. Fax: 011-44-83-1540. E-mail: ayyaz75@gmail.com Copyright © 2009 by the International Society for Heart and Lung Transplantation. 1053-2498/09/$–see front matter. doi:10.1016/ j.healun.2008.12.014 290 CASE REPORTS