Orozco-Hernández, Erik J

ABSTRACT

This statement discusses how Donation after Circulatory Death (DCD) can expand the heart donor pool and improve access to transplantation, particularly in Mexico. It reviews key barriers to DCD implementation, including unavoidable warm ischemia, cost and logistical complexity, and ethical/legal concerns surrounding certain procurement strategies. Two established approaches are summarized: Direct Procurement and Perfusion (DPP) using ex situ normothermic perfusion platforms, and Thoracoabdominal Normothermic Regional Perfusion (TA-NRP), which allows in situ assessment but may raise “dead donor rule” concerns. Using the Johari Window framework, the author argues that some feasible solutions remain in a national “blind spot”. The paper highlights Rapid Recovery with Extended Ultra-Oxygenation Preservation (REUP) as a promising, lower-cost, reanimation-less strategy that may avoid expensive technology and ethical issues tied to reperfusion or ex situ systems. Early reported outcomes are presented as comparable to DPP and TA-NRP, including feasibility with prolonged “no-touch” periods and extended ischemic times. The author concludes that REUP could enable broader DCD adoption in Mexico, while emphasizing the need for further comparative and long-term studies.

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