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Updated: Aug 27, 2025
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Hemodynamic and Clinical Performance of Hearts Donated After Circulatory Death
David A D'Alessandro1, Stanley B Wolfe1, Asishana A Osho1
1Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
Insights
Donation after circulatory death (DCD) hearts offer a shorter wait time for heart transplants. While DCD hearts show temporary right heart dysfunction post-transplant, long-term outcomes are comparable to standard donation after brain death (DBD) hearts.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Heart donor organ demand exceeds supply, necessitating expanded donor pools.
- Donation after circulatory death (DCD) offers a potential solution to increase heart availability for patients with advanced heart failure.
Purpose of the Study:
- To compare the hemodynamic and clinical profiles of DCD hearts versus standard of care (SOC) hearts from donation after brain death (DBD).
Main Methods:
- Retrospective cohort study analyzing heart transplant recipients.
- Data included right heart catheterization, inotrope scores, echocardiograms, and clinical outcomes.
- Comparison between DCD and DBD heart recipients from April 2016 to February 2022.
Main Results:
- 47 DCD and 166 DBD hearts were transplanted; DCD offered significantly shorter median transplant times (17 vs. 70 days).
- DCD recipients experienced transient right heart dysfunction at 1 week post-transplant, which resolved by 3 weeks.
- 30-day and 1-year mortality rates were similar between DCD and DBD heart recipients.
Conclusions:
- Utilizing DCD hearts leads to transient post-transplant right heart dysfunction.
- Clinical outcomes for DCD heart transplantation are comparable to those using DBD hearts.
- DCD heart transplantation is a viable option to expand donor availability without compromising short-term outcomes.
Background:
Donor organ demand continues to outpace supply in heart transplantation. Utilization of donation after circulatory death (DCD) hearts could significantly increase heart donor availability for patients with advanced heart failure.
Objectives:
The purpose of this study was to describe hemodynamic and clinical profiles of DCD hearts in comparison to standard of care (SOC) hearts donated after brain death (DBD).
Methods:
This single-center retrospective cohort study of consecutive heart transplant recipients analyzed right heart catheterization measurements, inotrope scores, echocardiograms, and clinical outcomes between DCD and DBD heart recipients.
Results:
Between April 2016 and February 2022, 47 DCD and 166 SOC hearts were transplanted. Median time from DCD consent to transplant was significantly shorter compared with SOC waiting list time (17 days [6-28 days] vs 70 days [23-240 days]; P < 0.001). Right heart function was significantly impaired in DCD recipients compared with SOC recipients 1 week post-transplant (higher median right atrial pressure (10 mm Hg [8-13 mm Hg] vs 7 mm Hg [5-11 mm Hg]; P < 0.001), higher right atrial pressure to pulmonary capillary wedge pressure ratio (0.64 [0.54-0.82] vs 0.57 [0.43-0.73]; P = 0.016), and lower pulmonary arterial pulsatility index (1.66 [1.27-2.50] vs 2.52 [1.63-3.82]; P < 0.001), but was similar between groups by 3 weeks post-transplant. DCD and SOC recipient mortality was similar at 30 days (DCD 0 vs SOC 2%; P = 0.29) and 1 year post-transplant (DCD 3% vs SOC 8%; P = 0.16).
Conclusions:
DCD heart utilization is associated with transient post-transplant right heart dysfunction and short-term clinical outcomes otherwise similar to transplantation using DBD hearts.
