Surgical techniques for cardiac allograft procurement and perfusion in controlled donation after circulatory death

In the last decade, heart transplants using allografts from adult donors after circulatory death, in a controlled setting, controlled donation after circulatory death (cDCD) have been rapidly adopted and widely performed. The selection of retrieval methods has largely been determined by state or institutional guidelines concerning permissible postmortem procedures. A significant majority of cDCD heart recoveries have employed direct procurement and perfusion (DPP) followed by normothermic machine perfusion (NMP) for graft preservation. Another established method involves the thoracoabdominal normothermic regional perfusion (taNRP), which is then followed by either NMP or static cold storage. Processing, management and surgical techniques of heart allograft procurement after cDCD are herein described and discussed.