*Heart Preservation Techniques for Transplantation DOI: http://dx.doi.org/10.5772/intechopen.113937*

**Figure 4.**

*Donation pathway for DCD.*

members depending on hospital policies. In some circumstances, withdrawal of life support is allowed to be performed in the operating theater to minimize warm ischemic time. The donor is then observed for progression of cardiac arrest as indicated by no pulse pressure via an arterial pressure line (mechanical asystole) [8]. The donor is then observed with no interaction (stand-off period) after asystole for an additional 2–5 minutes to ensure the absence of autoresuscitation. Median sternotomy and laparotomy incisions are then performed simultaneously. The warm ischemic time of the DCD donor heart is considered as an end when cold cardioplegia is administered.

Thus "The total warm ischemic time" starts at the time of withdrawal of support and ends when the organ is perfused with cold cardioplegia. "Functional warm ischemic time" refers to the time which the onset of organ hypoperfusion, and typically starts when systolic blood pressure drops below 50 mmHg and ends when cold cardioplegia is infused [45]. Functional warm ischemic time reflects allograft ischemia. Based on previous studies, a DCD heart with functional warm ischemic time exceeding 30 minutes should be excluded from transplant [48, 49].
