Near-zero Ischemia After Prolonged Warm Ischemic Time: Beating-heart DCD Heart Transplantation Following Thoracoabdominal Normothermic Regional Perfusion

Background: Heart transplantation is limited by donor organ shortage and ischemia-reperfusion injury, particularly in donation after circulatory death (DCD). Thoracoabdominal normothermic regional perfusion (TANRP) enables in situ myocardial resuscitation and assessment, while beating-heart strategies further reduce ischemic exposure. Methods: We report a DCD heart transplantation performed using in situ TANRP followed by beating-heart procurement, short-distance transfer without coronary flow, and implantation under continuous normothermic blood perfusion using the recipient cardiopulmonary bypass circuit. Results: Graft ischemic time was near zero. Immediate graft function was achieved, and no early postoperative complications were observed. Conclusions: This case supports the technical feasibility of an almost fully ischemia-sparing, beating-heart transplantation strategy after TANRP in DCD donation. Further experience is required to assess reproducibility, safety, and clinical impact.