[How to Consider the Heart Transplantation from the Donor after Circulatory Death in Japan].

The donation of the organs after brain death (DBD) has increased after the revision of the law in 2010 and the total number of heart transplantation( HTx) has reached to over 500 in Japan. However, donor shortage is critical as the annual number as remaining under 100 with unneglectable number of waiting deaths. Recently, HTx under donation after controlled circulatory death( cDCD) has been promoted in United Kingdom (UK) and Australia with promising outcomes. The cDCD appears to be an important option to expand the donor pool in Japan. Nation-wide and cross-cutting action among transplantation organs is warranted. Status of cDCD HTx in abroad and the domestic issues are reviewed.

Clinical Experience of Percutaneous Cardiopulmonary Support.

Recently, percutaneous cardiopulmonary support (PCPS) combined with femoro-femoral bypass without reservoir has become valued because of its quick and easy application. We developed a fully preconnected compact integrated cardiopulmonary bypass (CPB) unit (priming volume of 250 ml) with a blind pore membrane oxygenator (Kuraray Menox) for PCPS. From 1990 to 1995, PCPS was performed in 49 patients of whom 26 were weaned from support. In most cases, we applied this CICU in patients with no active bleeding (22 patients); in patients with active bleeding (n = 13), we used Medtron-ic's heparin-bonded close chest support pack (CCSP). Of these, PCPS was performed uneventfully for 2 h (median) in 8 elective cases; all of these patients were weaned or were switched to a left ventricular assist system (LVAS). In 8 urgent cases, such as those with low cardiac output syndrome, PCPS was performed for 4 days (median), 1 was weaned, and 2 CICU were cases switched to other procedures. In 32 cases of shock, 5 CICU patients were weaned, and 3 of them survived. Eight patients including 5 CICU patients and 1 CCSP patient were switched to operation or LVAS, and 2 CICU patients remain alive. From these data, PCPS has been shown to support the patient's circulation in the acute phase and earn time to switch to operation or LVAS; the quick and easy set-up of the CICU can improve the clinical results. The use of the Medtronic device broadened the indication for PCPS. The CCSP enlarged the indication of PCPS but could not improve the results. To improve the results, a heparin-bonded surface is desired.