Related Experiment Video
Updated: Aug 13, 2026
Brain Death Induction in Mice Using Intra-Arterial Blood Pressure Monitoring and Ventilation via Tracheostomy
Published on: April 17, 2020
Later Brain Death Declaration Correlates to Favorable Donor Characteristics but Decreased Heart Acceptance
Jason W Greenberg1, Eashwar C Kantemneni, Kevin Kulshrestha
1The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH.
Insights
Timing of brain death declaration (BDD) impacts donor heart utilization. Later BDD is linked to increased discard rates, despite similar donor profiles, leading to fewer transplants. Optimizing utilization of these donors can improve transplant rates without affecting outcomes.
Area of Science:
- Transplantation Medicine
- Organ Donor Management
- Cardiology
Background:
- High rates of donor heart discard nationally necessitate quality improvement efforts to optimize donor utilization.
- The impact of the timing of donor brain death declaration (BDD) on organ acceptance remains understudied.
- This study investigates the influence of the time interval between donor hospital admission and BDD on heart utilization and posttransplant outcomes.
Purpose of the Study:
- To characterize the impact of the time between donor hospital admission and brain death declaration (BDD) on heart utilization.
- To assess the effect of admission-to-BDD timing on posttransplant outcomes for heart recipients.
- To identify potential strategies for optimizing donor heart utilization by analyzing the association between BDD timing and organ acceptance.
Main Methods:
- Utilized the United Network for Organ Sharing database (2006-2021) to identify all potential heart donors and recipients.
- Categorized donors into admission-to-BDD cohorts: 1-2 days, 3-4 days, 5-7 days, and 8-10 days.
- Employed multivariable binary logistic regression to assess donor acceptance and Kaplan-Meier method for recipient posttransplant survival.
Main Results:
- Donor demographics and comorbidity profiles were comparable across admission-to-BDD cohorts.
- Later BDD cohorts showed higher rates of anoxia/overdose deaths and cardiopulmonary resuscitation requirements, but lower renal dysfunction and inotrope needs.
- Heart donor acceptance decreased with longer admission-to-BDD intervals (36% for 1-2 days vs. 28% for 8-10 days), with intervals >4 days independently associated with lower acceptance odds (OR 0.79, P < 0.001).
- Recipient posttransplant survival was equivalent across all admission-to-BDD cohorts.
Conclusions:
- Donors with later brain death declaration (BDD) were disproportionately discarded, leading to an estimated 3000 fewer transplants during the study period.
- Despite similar or favorable clinical profiles, later BDD donors faced higher discard rates.
- Increased utilization of donors with later BDD, including those with high-risk characteristics, can improve transplantation rates without compromising patient outcomes.
Background:
With rates of potential donor heart discard as high as 66% nationally, quality improvement efforts must seek to optimize donor utilization. Whether the timing of donor brain death declaration (BDD) influences organ acceptance is understudied. The authors sought to characterize the impacts of time between donor hospital admission and BDD on heart utilization and posttransplant outcomes.
Methods:
All potential heart donors and recipients in the United Network for Organ Sharing database were identified (2006-2021). Admission-to-BDD cohorts were: 1 to 2 d (n = 52 469), 3 to 4 d (n = 44 033), 5 to 7 d (n = 24 509), and 8 to 10 d (n = 8576). Donor clinical characteristics were compared between cohorts, and donor acceptance was assessed using multivariable binary logistic regression. Recipient posttransplant survival was assessed with the Kaplan-Meier method.
Results:
Donor demographics and comorbidity profiles (diabetes and hypertension) were comparable across cohorts. Anoxia/overdose deaths were more common (10% > 21% > 24% > 18%, respectively) and cardiopulmonary resuscitation requirements were higher (37% > 52% > 58% > 47%) when BDD occurred longer after admission. Renal dysfunction (44% > 44% > 35% > 29%) and inotrope requirements (52% > 25% > 36% > 29%) were lower in the later BDD cohorts. Proportions of hepatic dysfunction (18%-21%) and left ventricular ejection fraction <50% (13%-16%) were clinically equivalent. Donor acceptance differed by admission-to-BDD cohort (36% [1-2 d], 34% [3-4 d], 30% [5-7 d], and 28% [8-10 d]). Admission-to-BDD >4 d was independently associated with lower odds of acceptance on multivariable analysis (odds ratio 0.79, P < 0.001). Recipients experienced equivalent posttransplant survival for all donor admission-to-BDD cohorts ( P = 0.999 adults and P = 0.260 pediatrics).
Conclusions:
Heart donors with later BDD were disproportionately discarded despite similar-to-favorable overall clinical profiles, resulting in nearly 3000 fewer transplants during the study. Increased utilization of donors with later BDD and "high-risk" characteristics (eg, anoxia/overdose, cardiopulmonary resuscitation requirement) can improve rates of transplantation without compromising outcomes.
