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J Vis Exp. 2019 Aug 2;(150). doi: 10.3791/59789.

Pre-clinical Model of Cardiac Donation after Circulatory Death.

Author information

1
Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM).
2
Deparment of pharmacology and physiology, Faculty of Medicine, Université de Montréal.
3
Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network.
4
Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM); Department of surgery, Faculty of Medicine, Université de Montréal.
5
Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM); Department of surgery, Faculty of Medicine, Université de Montréal; noiseuxn@videotron.ca.
#
Contributed equally

Abstract

Cardiac transplantation demand is on the rise; nevertheless, organ availability is limited due to a paucity of suitable donors. Organ donation after circulatory death (DCD) is a solution to address this limited availability, but due to a period of prolonged warm ischemia and the risk of tissue injury, its routine use in cardiac transplantation is seldom seen. In this manuscript we provide a detailed protocol closely mimicking current clinical practices in the context of DCD with continuous monitoring of heart function, allowing for the evaluation of novel cardioprotective strategies and interventions to decrease ischemia-reperfusion injury. In this model, the DCD protocol is initiated in anesthetized Lewis rats by stopping ventilation to induce circulatory death. When systolic blood pressure drops below 30 mmHg, the warm ischemic time is initiated. After a pre-set warm ischemic period, hearts are flushed with a normothermic cardioplegic solution, procured, and mounted onto a Langendorff ex vivo heart perfusion system. Following 10 min of initial reperfusion and stabilization, cardiac reconditioning is continuously evaluated for 60 min using intraventricular pressure monitoring. A heart injury is assessed by measuring cardiac troponin T and the infarct size is quantified by histological staining. The warm ischemic time can be modulated and tailored to develop the desired amount of structural and functional damage. This simple protocol allows for the evaluation of different cardioprotective conditioning strategies introduced at the moment of cardioplegia, initial reperfusion and/or during ex vivo perfusion. Findings obtained from this protocol can be reproduced in large models, facilitating clinical translation.

PMID:
31424438
DOI:
10.3791/59789

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