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.

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 …

许多患者死于美国移植等待名单上，因为脑死亡后捐献的心脏比受益于移植的患者少得多。因此，常规移植脑死亡后心脏扩大的标准捐献，否则将被认为是劣等的。脑死亡心脏后扩大标准捐赠的例子包括距离更远，心脏功能较低和较高风险特征（例如丙型肝炎）的年长捐赠者。为满足对捐赠者心脏的迫切需求，澳大利亚有少数移植中心欧洲和欧洲通过在心脏死亡后捐款（DCD）之后开创了心脏移植领域，进一步推波助澜。^1个DCD供体的死亡是根据不可逆的心脏骤停而不是整个脑部所有功能的不可逆丧失而宣布的。²但是，由于DCD心脏采购的手术技术引起了独特的伦理和法律关注，因此在美国没有临床上活跃的DCD心脏移植计划。

DCD捐赠者和位于捐赠者附近的手术室中的接受者使得克里斯蒂安·巴纳德（Christiaan Barnard）于1967年进行了首次人类心脏移植。³此开创性医学成就在伦理争议中受到损害，从而导致1968年哈佛判定脑死亡为标准^。4脑死亡心脏移植后，后来放弃了DCD心脏移植，转而倾向于捐献，因为DCD心脏由于对缺血性的关注而被认为次于心脏供体心脏受伤。

对DCD心脏感兴趣...