History of DCD Heart
The world’s first successful heart transplant by Christian Barnard in 1967 was from a DCD donor, as brain stem testing had not been recognised at that point. Following the introduction of brain stem testing in the late 1970’s, all heart transplants were taken from DBD donors as the donation process was simpler and assessment of the heart was more reliable. Hearts also no longer had to endure the short period of no blood flow.
In 2008 doctors in Colorado, United States, published a series of 3 paediatric heart transplants from DCD donors. This was the first reported use of DCD donors for heart transplantation in the modern era. These children did very well and were discharged home after 3 weeks. Although it was a very exciting development, it was not adopted at Papworth at that time, as it is well recognized that children’s hearts are more resilient and additional research work had to be carried out on adult DCD hearts. Additionally, the used a technique whereby the donor and the recipient were in the same hospital, so called ‘co-location’ which was also employed by Barnard and colleagues when performing the first heart transplant back in 1967.
In 2014, surgeons at St Vincent’s Hospital, Sydney, Australia performed the world’s first DCD heart transplant using a donor organ from a different hospital site to the recipient patient. They published their initial case series in the Lancet reporting the successful transplantation of 3 adult patients with DCD hearts using the TransMedics Organ Care System. This paved the way for more widespread use of DCD hearts for adult heart transplants. They have since transplanted a further 7 patients.
In the UK, in early 2015, the team at Papworth performed Europe’s first DCD heart transplant using a novel technique to that of the group from Sydney. This technique allowed for more extensive assessment of the donor heart and has since enabled the evolution of DCD heart transplantation in the UK to allow for more people to successfully donate a DCD heart. Papworth employs both techniques that are currently practiced in the UK and has amassed the largest experience of DCD heart transplantation globally having performed 20 DCD heart transplants to date.