Emory Healthcare is at the forefront of a donation after cardiac death (DCD) movement. As the eighth-largest utilizer of DCD organs in the US, Emory Healthcare's commitment to advancing this modality showcases a dedication to addressing the organ shortage crisis and improving patient outcomes. Emory is also the first and only transplant center in Georgia to use DCD hearts and DCD lungs, providing patients with a significant advantage by offering access to more, younger, and potentially better organs.
Mani Daneshmand, MD, director of the Heart and Lung Transplantation, Mechanical Circulatory Support, and ECMO programs at Emory Healthcare, emphasizes the significance of innovation in organ transplantation: "At Emory, we are dedicated to pushing the boundaries of what is possible in transplantation medicine. The advancements in machine perfusion and our commitment to utilizing DCD organs not only address the organ shortage crisis but also dramatically improve patient outcomes. By embracing cutting-edge technologies and fostering a culture of collaboration and innovation, we are transforming lives and setting new standards in the field."
Historically, organ donation was predominantly reliant on donors who were declared brain dead. However, the emergence of DCD has broadened the donor pool, significantly impacting transplant availability and outcomes.
"When I got here last fall, the wait time from listing to transplant was over a year at Emory," says Marwan Kazimi, MD, surgical director for the Liver Transplant Program in the Emory Transplant Center. "After five months of using machine perfusion, we were down to an average of two and a half weeks from listing to transplant."
How Emory Is Leading the Way With DCD
DCD involves organ donation after the cessation of cardiac function, a process that presents unique challenges but also offers opportunities to save lives.
In partnership with Organ Procurement Organizations like LifeLink of Georgia, Emory Healthcare has embraced innovative approaches to enhance the viability and success rates of DCD organs. One such innovation is machine perfusion, which preserves organs outside the body. According to Emory transplant surgeons, machine perfusion has allowed Emory to extend the preservation time of DCD organs, significantly improving their viability – going out as far as 34 hours from procurement to implantation.
Emory will accept normothermic regional perfusion (NRP) organs procured by other centers but prioritizes machine perfusion due to superior outcomes. Machine profusion allows functional organ testing, which is not possible with traditional DCD retrieval NRP.
Machine perfusion has also transformed the logistical aspects of DCD. Previously, the unpredictability of cardiac cessation and the mandatory wait time posed significant challenges. With the ability to preserve organs for extended periods, Emory can test to ensure organs are functional before calling in recipients, reducing unnecessary hospital admissions and improving overall efficiency.
Emory's donor advisory committee, comprising members from various medical backgrounds, facilitates transparent communication and ensures ethical integrity in the DCD process.
Looking Ahead
Dr. Kazimi attributes the success of Emory's DCD program to innovation and collaboration.
"It's been a willingness on the part of the surgeons, the hepatologists, and the physicians to push the envelope and explore," he says. "It's been support from administration. It's been excitement on the part of our coordinators who call patients in to figure out the logistics of setting up cases. And it’s been having patients on the list who have been waiting for quite some time, ready to be transplanted."
Looking ahead, Emory aims to further refine the DCD program by exploring the cellular and molecular changes that occur during machine perfusion. By understanding these mechanisms, the Emory transplant teams hope to "push the envelope” in terms of donor criteria, potentially extending the age limit for donors and further increasing organ availability.
Additionally, Emory is exploring the potential of DCD in transplant oncology, which would offer hope for patients with conditions such as colorectal metastases and intrahepatic cholangiocarcinoma.
To refer a patient to Emory Heart & Vascular, call our physician consult line at 404-778-5050.