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Updated: Apr 21, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Addition of long-distance heart procurement promotes changes in heart transplant waiting list status
Fernando Antibas Atik1, Carolina Fatima Couto1, Freddy Ponce Tirado1
1Instituto de Cardiologia do Distrito Federal, Brasília, DF, Brazil.
Insights
Expanding heart procurement to long distances, despite longer ischemic times, does not increase heart transplant risks. This strategy enhances the donor pool, potentially reducing waitlist mortality and times for recipients.
Area of Science:
- Cardiology
- Transplant Surgery
- Organ Donation
Background:
- Heart transplantation is a life-saving procedure for end-stage heart failure.
- Limited donor availability and geographical constraints can impact transplant rates.
- Optimizing donor organ utilization is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the impact of incorporating long-distance heart procurement on a heart transplant program.
- To assess the effect on heart transplant recipients on the waiting list.
- To analyze changes in transplant center volume and waiting list dynamics.
Main Methods:
- A retrospective analysis of heart transplant recipients listed between September 2006 and October 2012.
- Comparison of outcomes between local donor procurements and long-distance, interstate procurements initiated in February 2011.
- Evaluation of key metrics including ischemic times, graft dysfunction, survival rates, transplant volume, and waiting list times/mortality.
Main Results:
- Long-distance procurement involved 27% of transplants (mean distance 792 km) and was associated with longer ischemic times (212 min vs. 90 min).
- Primary graft dysfunction and 1-month/12-month survival rates were similar between local and long-distance groups.
- Transplant center volume increased significantly (64.4% vs. 40.7%), with trends towards reduced waiting list times and mortality.
Conclusions:
- Long-distance heart procurement is a safe addition to heart transplant programs, not increasing post-transplant morbidity or mortality.
- It effectively expands the donor organ pool, addressing geographical limitations.
- This approach shows potential to decrease waiting list recipient mortality and reduce overall waiting times.
Objective:
Evaluate the addition of long-distance heart procurement on a heart transplant program and the status of heart transplant recipients waiting list.
Methods:
Between September 2006 and October 2012, 72 patients were listed as heart transplant recipients. Heart transplant was performed in 41 (57%), death on the waiting list occurred in 26 (36%) and heart recovery occurred in 5 (7%). Initially, all transplants were performed with local donors. Long-distance, interstate heart procurement initiated in February 2011. Thirty (73%) transplants were performed with local donors and 11 (27%) with long-distance donors (mean distance=792 km±397).
Results:
Patients submitted to interstate heart procurement had greater ischemic times (212 min ± 32 versus 90 min±18; P<0.0001). Primary graft dysfunction (distance 9.1% versus local 26.7%; P=0.23) and 1 month and 12 months actuarial survival (distance 90.1% and 90.1% versus local 90% and 86.2%; P=0.65 log rank) were similar among groups. There were marked incremental transplant center volume (64.4% versus 40.7%, P=0.05) with a tendency on less waiting list times (median 1.5 month versus 2.4 months, P=0.18). There was a tendency on reduced waiting list mortality (28.9% versus 48.2%, P=0.09).
Conclusion:
Incorporation of long-distance heart procurement, despite being associated with longer ischemic times, does not increase morbidity and mortality rates after heart transplant. It enhances viable donor pool, and it may reduce waiting list recipient mortality as well as waiting time.
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