DCD heart transplantation with prolonged functional warm and cold ischemic time using controlled hypothermic preservation: A case report.

We describe the case of successful heart transplantation following donation after circulatory death (DCD) with a prolonged functional ischemic time (43 minutes), which was performed using the Paragonix SherpaPak Cardiac Transport System (SCTS). Due to a mandatory stand-down period of 20 minutes for the confirmation of circulatory death, DCD heart transplantation has so far been considered prohibitive in Italy. Thanks to the very recent implementation of a new national DCD heart protocol, a 24-year-old male with arrhythmogenic right ventricular cardiomyopathy underwent successful heart transplantation with a DCD graft using thoracoabdominal normothermic regional perfusion via femoral vessel cannulation and use of aortic endo-clamp, followed by sternotomy, aortic cross-clamping, and cardioplegia administration in the aortic root. After graft harvesting, SCTS was used for controlled hypothermic preservation during transportation. This case provides novel insights into the myocardial recovery potential following sustained ischemia and highlights the possibility of further expanding the donor's pool using DCD hearts even in countries with prolonged stand-down periods required by law.