A Survey of the Practices of Storage and Transport for Donor Heart in India

Sarvesh Pal Singh; Milind Padmakar Hote; Sandeep Seth; Manoj Durairaj; Anvay Mulay; KG Suresh Rao; Kewal Krishan; Julius Punnen; KR Balakrishnan; Alla Gopala Krishan Gokhale

doi:10.4103/jpcs.jpcs_58_20

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ORIGINAL ARTICLE

Year : 2020 | Volume : 6 | Issue : 3 | Page : 264-269

A Survey of the Practices of Storage and Transport for Donor Heart in India

Sarvesh Pal Singh¹, Milind Padmakar Hote¹, Sandeep Seth², Manoj Durairaj³, Anvay Mulay⁴, KG Suresh Rao⁵, Kewal Krishan⁶, Julius Punnen⁷, KR Balakrishnan⁵, Alla Gopala Krishan Gokhale⁸
¹ Department of Cardiothoracic and Vascular Surgery, C T Center, All India Institute of Medical Sciences, New Delhi, India
² Department of Cardiology, C T Center, All India Institute of Medical Sciences, New Delhi, India
³ Marian Cardiac Center and Research Foundation, Pune, India
⁴ Department of Cardiothoracic and Vascular Surgery, Sir HN Reliance Hospital, Mumbai, Maharashtra, India
⁵ Department of Cardiothoracic and Vascular Surgery, Institute of Heart and Lung Transplant, MGM Healthcare, Chennai, Tamil Nadu, India
⁶ Department of Cardiovascular Surgery, Max Heart and Vascular Institute, New Delhi, India
⁷ Department of Cardiovascular Surgery, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
⁸ Department of Cardiothoracic Surgery, Apollo Hospitals, Hyderabad, Telangana, India

Correspondence Address:
Dr. Sarvesh Pal Singh
Department of Cardio-Thoracic and Vascular Surgery, C T Center, All India Institute of Medical Sciences, Room No 5, 7^th Floor, New Delhi - 110 029
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jpcs.jpcs_58_20

Background: Heart transplant remains the gold standard for the treatment of end-stage heart failure. The most common method of donor heart preservation, during transport, is “triple-bag technique” with static cold storage (SCS). The safe duration of storage (ischemic time) for a donor heart with SCS is 4 h shortest among all the transplantable solid organs. One of the factors determining the donor heart's quality is the storage and transport of the donor organ. This study identified the centers which perform heart transplants routinely (≥7 per year) for the past 3 years and compared the differences between their donor heart storage and transport practices. Methodology: After obtaining ethical clearance from the Institutional Ethics Committee, this survey was done among the centers performing heart transplants in India. Centers performing an average of ≥7 heart transplants per year for the past consecutive 3 years were identified and included in the study. Centers that refused to participate or did not respond to a maximum of 3 reminders to send the filled questionnaire were excluded from the survey. A total of 11 transplant teams fulfilled the inclusion criteria, but only eight units responded to the request. The authors identified the team leaders in all the transplant teams and obtained concurrence before sharing an indigenous questionnaire about the practice of storage and transport of donor heart followed in their centers. Teams were contacted by digital platforms and telephone. Results: The analysis of current practices for donor heart preservation reveals that the triple-bag technique is the most commonly used method for SCS of donor heart, and Custodiol HTK is the most commonly used solution for cardioplegia. The dose of Custodiol varies between 25 and 50 ml/kg in different centers. It is also a common practice to immerse the heart in cold Custodiol solution in the first bag. Although any donor retrieval team does not measure the temperature, every team claims the temperature of the preservative solution used for flushing is 0°C–4°C. All the participating teams use ice cubes or slush in the transport box around the heart encased in 3 plastic bags. Conclusions: The authors of this survey conclude that the triple bag technique use may not be essential and can be converted to a two-bag technique as practiced by a couple of units. The use of cold Custodiol solution in the first bag probably has no rationale, and the use of 0.9% saline is a non-inferior cost-effective option. Ice slush may be avoided in the first bag because of the theoretical possibility of triggering a freeze in the donor heart.

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