Heart transplantation from donation after circulatory death: Impact on waitlist time and transplant rate

Area of Science:

• Cardiology
• Transplantation Medicine
• Organ Donation

Background:

• The impact of donation after circulatory death (DCD) hearts on heart transplant (HT) waitlist outcomes requires further substantiation.
• Previous studies have not definitively established the benefits of DCD heart utilization in improving patient access to transplantation.

Purpose of the Study:

• To evaluate the effect of initiating an adult DCD heart transplant program on waitlist outcomes.
• To compare transplant rates, waitlist times, and mortality between pre-DCD and post-DCD implementation periods.

Main Methods:

• Retrospective analysis of 184 heart transplant candidates from 2019 to 2021.
• Stratification into two periods: pre-DCD (before Sept 12, 2020) and post-DCD (after Sept 12, 2020).
• Comparison of primary outcomes (transplant rate) and secondary outcomes (waitlist time, mortality, post-transplant survival).

Main Results:

• The median waitlist time-to-transplant decreased significantly from 47.5 to 19 days (P = .004).
• The transplant rate increased from 181 to 579 per 100 patient-years (IRR, 1.87; P = .038).
• No significant differences were observed in waitlist mortality rate (P = .566) or 1-year survival (P = .699).

Conclusions:

• Utilization of DCD hearts significantly reduces heart transplant waitlist times and increases the overall transplant rate.
• Short-term post-transplant outcomes following DCD heart transplantation are comparable to those from donation after brain death.
• DCD hearts represent a valuable resource, contributing substantially to increased heart transplant activity.