Pushing the limits of death-Rapid ultraoxygenated recovery without preimplant heart reanimation in circulatory death with prolonged "no-touch" period.

Cardiac allografts from donation after circulatory death (DCD) donors have increased the donor pool in adult heart transplantation. Historically, techniques to reanimate DCD hearts before implantation have been used to ensure graft viability and function. Our group has recently described a novel method for the rapid ultraoxygenated recovery of DCD hearts for transplantation without the need for preimplant reanimation. Concerns remain regarding its worldwide application in prolonged "no-touch" scenarios, such as the 20-minute asystole observation period in Italy. Here, we highlight the use of our rapid recovery with extended ultraoxygenation preservation technique for the recovery of a 32-year-old donor cardiac allograft with a prolonged "no-touch" period of circulatory arrest. Despite 37 minutes of circulatory arrest before donor heart preservation, including 14 minutes of pulseless electrical activity followed by 23 minutes asystole, the recipient underwent successful heart transplantation with normal biventricular function and excellent outcomes postoperatively.