{'fraction_non_alphanumeric': 0.015734265734265736, 'fraction_numerical': 0.0021853146853146855, 'mean_word_length': 5.521367521367521, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Heart transplantation from donation after circulatory death donors.

Donation after circulatory death (DCD) has emerged over the last decade as an increasingly used pathway to deceased organ donation. This has led to substantial increase particularly for renal transplants. Although livers, lungs, and pancreata have been used from DCD donors, there has been concern on detrimental effects of warm ischemia on extrarenal organs. The 1 organ that has been left behind almost entirely in this increasingly important area of deceased organ donation is the heart as being most susceptible to ischemic injury. In addition, as implied by the older term“nonheart-beatingdonation,”itisthearrestoftheheart that leads to cessation of the circulation, and until recently, it has not been possible to assess either the severity or the reversibility of the ischemic injury which inevitably affects the heart in the DCD setting. Furthermore, the unfortunate widespread use of the medicolegally incorrect term “donation after cardiac death” has created the false impression even in the minds of many health professionals that the heart “dies” during withdrawal of life support and that this is critical to the determination of death of the donor. How then is it possible to reanimate and transplant a “dead” heart? The medical and legal definition of death after withdrawal oflifesupportisirreversiblecessationofthecirculation.Jurisdictions vary in the observation time that is legally required before cessation of the circulation can be assessed as being irreversible. Most jurisdictions have legislated an observation timeof5 minutes before death canbe declaredafter cessation of circulation; however, some have determined this to be as short as 2 minutes in line with the original Pittsburgh Protocol 1 and more recent international consensus guidelines. 2 Under these circumstances, the heart is no different than any other transplantable organ. It has stopped functioning but remains viable for a short period of time after death of the donor. Where it differs from other organs is in its greater susceptibility to the unavoidable warm ischemic injury that occurs during withdrawal of life support and during the interval between circulatory arrest and delivery of myocardial preservation solution.