Heart Donation After Controlled Circulatory Death in Noncardiac Surgery Hospitals With a Mobile Heart Team: A Case Series From an Italian Regional Program and Integrated Review of the Literature.

Controlled donation after circulatory death (cDCD) with thoracoabdominal normothermic regional perfusion (TA-NRP) has emerged worldwide as a strategy to expand the heart donor pool. In Italy, however, its implementation is constrained by a particularly restrictive setting, shaped by the mandatory 20-min asystolic no-touch period and by the absence of cardiac surgery units in most donor hospitals. Against this backdrop, the Emilia-Romagna Regional Transplant Network developed a mobile DCD Heart Team capable of performing TA-NRP in peripheral hospitals. We report a case series of 19 cDCD donors managed with TA-NRP within a regional program based at a high-volume tertiary university hospital, all with prolonged functional warm ischemic time (FWIT). Seventeen hearts (89.5%) were successfully procured and transplanted, with a median FWIT of 41 (37.5-52) minutes, and serial transesophageal echocardiography and hemodynamic assessment supported real-time monitoring of myocardial recovery. No recipient required postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO), and no primary graft dysfunction or 30-day mortality were observed. These findings support TA-NRP heart procurement as a feasible and clinically effective procedure-even in centers without onsite cardiac surgery-when a dedicated mobile heart team is available, thereby encouraging the broad adoption of cDCD heart procurement within the Italian legislative and organizational context.