Related Experiment Video
Updated: Aug 21, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Cardiovascular mechanism of donor brain death and heart recipient survival
Christopher W Jensen1, Oliver K Jawitz1,2, Abigail R Benkert1
1Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
Insights
Heart donation from donors with cardiovascular mechanism of brain death (CV-DBD) after cardiac arrest is safe for recipients. This study found no increased recipient mortality risk, suggesting CV-DBD hearts are viable for transplantation with careful assessment.
Area of Science:
- Cardiology
- Transplantation Immunology
- Organ Donation
Background:
- Heart donation after donor brain death from cardiac arrest (CV-DBD) may raise concerns about graft ischemia and recipient outcomes.
- However, selected CV-DBD donor hearts often maintain normal function and anatomy.
- This study aimed to clarify the association between CV-DBD grafts and recipient survival.
Purpose of the Study:
- To investigate whether heart grafts from donors experiencing cardiovascular mechanism of brain death (CV-DBD) are associated with worse recipient outcomes.
- To determine if CV-DBD organ status independently impacts heart transplant recipient mortality.
Main Methods:
- Utilized the United Network for Organ Sharing (UNOS) database for adult heart transplant recipients and donors (January 2005-March 2021).
- Stratified recipients based on donor status: CV-DBD versus non-CV-DBD.
- Performed multivariable Cox proportional hazards modeling to assess the association with mortality.
Main Results:
- Analyzed 35,833 heart transplants; 7.5% involved CV-DBD grafts.
- CV-DBD donors were more likely to be female, older, and have comorbidities like diabetes and hypertension.
- Unadjusted analysis showed reduced survival for CV-DBD recipients, but this was not significant after multivariable adjustment (HR: 1.05, p=0.28).
Conclusions:
- CV-DBD status was not associated with adjusted recipient mortality in a large cohort of heart transplants.
- Donor brain death due to cardiac arrest should not be an absolute contraindication for heart donation.
- Careful assessment of graft function remains crucial before transplantation.
Background:
Heart donation after donor brain death from cardiac arrest despite successful resuscitation may be associated with worse recipient outcomes due to potential graft ischemia or underlying rhythmic/structural defects. However, selected grafts from such donors often have normal cardiac function and anatomy. We investigated whether a cardiovascular mechanism of donor brain death (CV-DBD) was associated with worse recipient outcomes.
Methods:
We queried the United Network for Organ Sharing (UNOS) database for first-time, single-organ, adult (age 18+) heart transplant recipients and their associated donors between January 2005 and March 2021. Recipients were stratified by donor status (CV-DBD vs. non-CV-DBD). We performed multivariable Cox proportional hazards modeling to ascertain whether receiving a CV-DBD graft was independently associated with mortality.
Results:
Of 35,833 included recipients, 2,702 (7.5%) received CV-DBD grafts. The associated donors were significantly more likely to be female, older, and have a history of diabetes, hypertension, and substance use (all p < .001). On unadjusted Kaplan-Meier analysis, CV-DBD recipients had a significantly reduced median survival than non-CV-DBD recipients (12.0 vs. 13.1 years, log-rank p = .04). However, after adjusting for donor/recipient age, recipient comorbidities, annualized center volume, and transplantation era, CV-DBD organ status was not associated with recipient mortality (hazard ratio: 1.05, 95% confidence interval: 0.96-1.13, p = .28).
Conclusion:
In this analysis of over 35,000 heart transplants, CV-DBD status was not associated with adjusted recipient survival. Donor brain death due to cardiac arrest should not be an absolute contraindication to heart donation, although graft function should be carefully assessed before transplantation.
