Heart and Lungs Donation after Complete Cardiac Death - Part 1

Heart and Lung Donation After Circulatory Death (DCD) is a carefully coordinated process that allows organ recovery after the irreversible cessation of circulatory function. The procedure begins with the identification of a suitable donor, typically a patient with devastating neurologic or non-recoverable illness who does not meet brain-death criteria but for whom withdrawal of life-sustaining therapy has been decided according to ethical and legal standards. After obtaining informed consent for organ donation from the family, the donor is transferred to the operating room or a designated withdrawal area where monitoring and preparation occur. Withdrawal of life-sustaining treatment (WLST) is then performed, and the medical team observes the patient until circulatory arrest occurs, defined by the absence of pulse, blood pressure, and cardiac activity. Following this, a mandatory no-touch period (typically 2–5 minutes depending on institutional policy) is observed to confirm irreversible circulatory death. Once death is declared, rapid surgical access and organ preservation are initiated to minimize warm ischemia time. For lung procurement, the pulmonary artery is cannulated and flushed with a cold preservation solution while ventilation with low tidal volumes may be resumed to maintain alveolar integrity. For heart recovery, different strategies may be employed, including direct procurement followed by ex-situ perfusion using a normothermic perfusion system or thoraco-abdominal normothermic regional perfusion (NRP) to restore organ perfusion while excluding cerebral circulation. After stabilization and assessment of organ function, the heart and lungs are removed and either transplanted directly or further evaluated using ex-vivo perfusion systems such as EVLP for lungs or OCS for the heart. This structured protocol enables safe utilization of organs from DCD donors, significantly expanding the donor pool while maintaining ethical and physiological standards in transplantation medicine.