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the incidence of organ donation after circulatory death (DCD) is increasing; however, heart use has lagged behind other solid organs. Ex vivo perfusion devices are under United States Food and Drug Administration review for use in DCD heart recovery. This study sought to measure the potential increase in the donor pool if DCD heart donation becomes widely adopted.DCD donor data were obtained from Organ Procurement and Transplantation Network database. Selection criteria included donor age 18 to 49 years, donors meeting Maastricht III criteria, warm ischemia time ≤30 minutes, and donation between 2015 and 2020. Exclusion criteria were coronary disease, prior myocardial infarction, ejection fraction0.50, significant valve disease, bacteremia, pulmonary capillary wedge pressure15 mm Hg, and history of HIV/hepatitis C virus infections.There were 12 813 DCD donors during this period, of which 3528 met study criteria, and 70 hearts (2%) were transplanted. The use of DCD hearts would represent an additional 48 heart transplants per month, which corresponds to a 21% (3458 of 16 521) increase across the country. Median warm ischemia was 23 minutes, with no difference between hearts that were or were not transplanted (23 vs 22.5 minutes, P = .97). The frequency with which other organs were successfully transplanted was kidney, 92%; liver, 44%; lung, 7%; intestine, 0%; and pancreas, 2%.Wide adoption of DCD heart transplantation could yield a substantial increase in the donor pool size, with approximately 580 additional organs being available each year across the United States. This would represent the largest increase in the donor pool in the modern era of heart transplantation.

Background The COVID-19 pandemic has uniquely affected the United States. We hypothesize that transplantation would be uniquely affected. Methods In this population-based cohort study, adult transplantation data were examined as time series data. Autoregressive-integrated-moving-average models of transplantation rates were developed using data from 1990 to 2019 to forecast the 2020 expected rates in a theoretical scenario if the pandemic did not occur to generate observed-to-expected (O/E) ratios. Results 32,594 transplants were expected in 2020, and only 30,566 occurred (O/E 0.94, CI 0.88–0.99). 58,152 waitlist registrations were expected and 50,241 occurred (O/E 0.86, CI 0.80–0.94). O/E ratios of transplants were kidney 0.92 (0.86–0.98), liver 0.96 (0.89–1.04), heart 1.05 (0.91–1.23), and lung 0.92 (0.82–1.04). O/E ratios of registrations were kidney 0.84 (0.77–0.93), liver 0.95 (0.86–1.06), heart 0.99 (0.85–1.18), and lung 0.80 (0.70–0.94). Conclusions The COVID-19 pandemic was associated with a significant deficit in transplantation. The impact was strongest in kidney transplantation and waitlist registration.

Background: Tissue hypoxia plays a critical role in the events leading to cell death in ischemic stroke. Despite promising results in preclinical and small clinical pilot studies, inhaled oxygen supplementation has not translated to improved outcomes in large clinical trials. Moreover, clinical observations suggest that indiscriminate oxygen supplementation can adversely affect outcome, highlighting the need to develop novel approaches to selectively deliver oxygen to affected regions. This study tested the hypothesis that intravenous delivery of a novel oxygen carrier (Omniox-Ischemic Stroke [OMX-IS]), which selectively releases oxygen into severely ischemic tissue, could delay infarct progression in an established canine thromboembolic large vessel occlusion stroke model that replicates key dynamics of human infarct evolution. Methods: After endovascular placement of an autologous clot into the middle cerebral artery, animals received OMX-IS treatment or placebo 45 to 60 minutes after stroke onset. Perfusion-weighted magnetic resonance imaging was performed to define infarct progression dynamics to stratify animals into fast versus slow stroke evolvers. Serial diffusion-weighted magnetic resonance imaging was performed for up to 5 hours to quantify infarct evolution. Histology was performed postmortem to confirm final infarct size. Results: In fast evolvers, OMX-IS therapy substantially slowed infarct progression (by ≈1 hour, P P P =0.09). The final normalized infarct volume also did not show a significant difference (0.93 versus 0.95, OMX-IS drug versus control, P =0.34). Postmortem histologically determined infarct volumes showed excellent concordance with the magnetic resonance imaging defined ischemic lesion volume (bias: 1.33% [95% CI, −15% to 18%). Conclusions: Intravenous delivery of a novel oxygen carrier is a promising approach to delay infarct progression after ischemic stroke, especially in treating patients with large vessel occlusion stroke who cannot undergo definitive reperfusion therapy within a timely fashion.

Modeling studies and observations show that the thermohaline properties of the North West European Shelf Seas (NWESS) are sensitive to surface wind and heat flux forcing, as well as river outflows that transport fresh water from land to the ocean. In previous studies, it was assumed that the variability of the thermohaline properties in response to river outflow could be adequately sampled with a high-resolution, submesoscale permitting, long-term (i.e., 30-year) deterministic hindcast. In this study, we assume that the statistical distribution of the river forcing, rather than the time series of forcing itself, is adequately constrained by a 28-year history (1991 to 2018) of river forcing created specifically for our domain. In this way, we created an ensemble of 10 lower-resolution ( 7-km), short-term (i.e., 2.5 years) hindcast models that are forced with randomly perturbed river outflows and an ensemble of surface fluxes from the 10-member ECMWF ERA5 reanalysis (the ‘Test’ ensemble) as well with a companion ensemble that is forced with the ERA5 surface forcing fluxes but unperturbed river outflows (the ‘Base’ ensemble) for the June 2016 through December 2018 time period. In both ensembles, the modeled evolution of 25-hour averaged (to partially filter out tides) temperature and salinity is realistic with peaks in summer for sea surface temperature and in winter for salinity, and annual amplitudes that are comparable to those found in other studies of the NWESS. The increased mean and standard deviation of the sea surface and bottom salinity in the Test ensemble are partly an artifact of the assumption that the errors in river forcing have a log-normal distribution that mimics the episodic nature of river outflow with a positive mean and an asymmetrical shape with a long tail towards large values. For surface density, the standard deviation in the Test ensemble was below 0.5 kg/m3, covering an areal extent larger than that for the Base ensemble throughout the year. The annual cycle of the areal extent of density in that range had a peak in summer and minima in winter, in phase with that of the river outflow forcing. Overall, the effect of uncertain river forcing on the thermohaline properties in this study is small. In order to understand the true impact of river forcings, better temporal and spatial observations of river outflow are needed.