Related Experiment Video
Updated: Jul 5, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Usage of older donors is associated with higher mortality after heart transplantation: A UNOS observational study
Abhishek Jaiswal1, Michelle Kittleson2, Ashwin Pillai1
1Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut.
Insights
Using hearts from older donors (≥45 years) for heart transplantation (HT) is linked to increased recipient mortality and graft failure. Donor age significantly impacts long-term HT outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Gerontology
Background:
- Heart transplantation (HT) recipient outcomes vary with older donor utilization.
- Uncertainty exists regarding the efficacy of using hearts from older donors.
Purpose of the Study:
- To examine the utilization and outcomes of heart transplants from older donors using a national registry.
- To explore the impact of the current donor heart allocation system on outcomes for older donor hearts.
Main Methods:
- Observational study using the United Network for Organ Sharing database (2015-2023).
- Donors categorized as <45 years or ≥45 years.
- Evaluated organ disposition, geographical variation, mortality rates, and graft failure.
Main Results:
- 15.0% of donors were ≥45 years; 15.6% of recipients received hearts from these donors.
- Older donors had higher comorbidities and shorter ischemic times.
- Recipients of older donor hearts showed significantly higher 1- and 3-year mortality and graft failure rates.
Conclusions:
- Older donor age (≥45 years) is associated with poorer long-term outcomes in heart transplant recipients.
- Mortality risk increases with donor age, particularly after 40 years.
Background:
Utilization of heart from older donors is variable across centers with uncertain outcomes of recipients. We sought to utilize a national registry to examine the usage and outcomes of heart transplant (HT) recipients from older donors. We also explored the impact of current donor heart allocation scheme on the outcomes of hearts from older donors.
Methods:
This observational study utilized the United Network for Organ Sharing database between 2015 and 2023 with donors categorized into age <45 years or ≥45 years and evaluated organ disposition and geographical variation. Thirty-day, 1-, and 3-year mortality, and graft failure rates were compared among recipients as per donor age group. We also evaluated annual trends in HT for each group over the follow-up period.
Results:
A total of 24,966 adult donors were recovered: 3,742 (15.0%) were ≥45 years; 3,349 (15.6%) adults received heart from such donors with significant geographical variation, and a declining utilization in the transplantation rate in current donor allocation system. Donors with age ≥45 years had higher comorbidities and were allotted with a significantly shorter ischemic time to recipients who were significantly less likely to receive temporary mechanical circulatory support and more likely female. Unadjusted and adjusted, 30-day mortality were similar but 1- and 3-year mortality and graft failure rates were significantly higher in recipients of such donors. Spline analysis suggested a higher 1-year mortality risk at older donor age with risk increasing after age 40 years.
Conclusions:
Older donor age was associated with worsened 1- and 3-year mortality and graft failure for heart transplant recipients.
