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Updated: Jul 23, 2025
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Left Ventricular Dysfunction Associated With Brain Death: Results From the Donor Heart Study
Kiran K Khush1, Darren Malinoski2, Helen Luikart1
1Division of Cardiovascular Medicine (K.K.K., H.L., B.W.).
Insights
Left ventricular dysfunction occurs in 13% of brain-dead organ donors, sometimes reversing. This impacts heart transplant acceptance but not recipient survival.
Area of Science:
- Cardiology
- Transplantation Medicine
- Critical Care Medicine
Background:
- Left ventricular dysfunction (LVD) in potential heart donors meeting brain death criteria often leads to donor heart nonuse.
- The incidence and pathophysiology of LVD in this population remain poorly understood.
- The Donor Heart Study (DHS) aimed to resolve these unknowns through a multisite prospective cohort study.
Purpose of the Study:
- To determine the incidence and characteristics of left ventricular dysfunction in potential organ donors.
- To assess the reversibility of LVD in brain-dead donors.
- To evaluate the association between LVD, donor heart acceptance, and recipient outcomes.
Main Methods:
- Enrolled 4333 potential donors by neurologic determination of death across 8 US organ procurement organizations.
- Performed serial transthoracic echocardiograms (TTEs) to assess left ventricular ejection fraction (LVEF) and regional wall motion abnormalities.
- Defined LVD as LVEF <50%, with reversibility if LVEF >50% on a subsequent TTE.
Main Results:
- Initial TTEs in 3794 donors revealed LVD in 13% (493 donors).
- LVD was associated with younger age, underweight status, and elevated NT-proBNP and troponin levels.
- Of 224 donors with initial LVD, 58% showed reversible dysfunction; 60% of hearts with normal function were accepted vs. 56% with reversible LVD and 24% with nonreversible LVD.
Conclusions:
- Left ventricular dysfunction is common in brain-dead donors and can be reversible.
- Findings can inform donor evaluation and heart acceptance decisions.
- Donor LVD, reversible or not, did not impact 1-year recipient survival.
Background:
Left ventricular dysfunction in potential donors meeting brain death criteria often results in nonuse of donor hearts for transplantation, yet little is known about its incidence or pathophysiology. Resolving these unknowns was a primary aim of the DHS (Donor Heart Study), a multisite prospective cohort study.
Methods:
The DHS enrolled potential donors by neurologic determination of death (n=4333) at 8 organ procurement organizations across the United States between February 2015 and May 2020. Data included medications administered, serial diagnostic tests, and transthoracic echocardiograms (TTEs) performed: (1) within 48 hours after brain death was formally diagnosed; and (2) 24±6 hours later if left ventricular (LV) dysfunction was initially present. LV dysfunction was defined as an LV ejection fraction <50% and was considered reversible if LV ejection fraction was >50% on the second TTE. TTEs were also examined for presence of LV regional wall motion abnormalities and their reversibility. We assessed associations between LV dysfunction, donor heart acceptance for transplantation, and recipient 1-year survival.
Results:
An initial TTE was interpreted for 3794 of the 4333 potential donors by neurologic determination of death. A total of 493 (13%) of these TTEs showed LV dysfunction. Among those donors with an initial TTE, LV dysfunction was associated with younger age, underweight, and higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) and troponin levels. A second TTE was performed within 24±6 hours for a subset of donors (n=224) with initial LV dysfunction; within this subset, 130 (58%) demonstrated reversibility. Sixty percent of donor hearts with normal LV function were accepted for transplant compared with 56% of hearts with reversible LV dysfunction and 24% of hearts with nonreversible LV dysfunction. Donor LV dysfunction, whether reversible or not, was not associated with recipient 1-year survival.
Conclusions:
LV dysfunction associated with brain death occurs in many potential heart donors and is sometimes reversible. These findings can inform decisions made during donor evaluation and help guide donor heart acceptance for transplantation.
