In this video tutorial, we describe the step-by-step procedure of a totally beating heart transplant in a setting of controlled donation after circulatory death. The donor and recipient of the cardiac allograft were present in the same hospital, the same operating block and different operating rooms. After a mandatory no-touch time of asystolic electrocardiographic registering, which per Italian law is 20 minutes, the sternum is opened and supra-aortic vessels are occluded. Thoraco-abdominal normothermic regional perfusion is promptly initiated, interrupting the warm ischaemia time. After the multiparametric evaluation of the cardiac allograft, its procurement from the donor, its transportation from the donor to the recipient and its subsequent implantation are performed completely on a beating heart. Cardiac perfusion in the aortic root was guaranteed continuously with the donor blood during procurement and transportation, and with the recipient blood from the cardiopulmonary bypass during the implantation. By avoiding the two periods of cold ischaemic cardiac arrest typically used in a donation after circulatory death setting, this procedure may reduce ischaemic cardiac injury and potentially improve the allograft performance after the transplant procedure.
Çelmeta et al. (2026) studied this question.