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Updated: Jul 5, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Donor Electrocardiogram Associations With Cardiac Dysfunction, Heart Transplant Use, and Survival: The Donor Heart
Natalie Tapaskar1, Brian Wayda1, Darren Malinoski2
1Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Insights
Electrocardiogram (ECG) abnormalities are frequent in potential heart donors post-brain death but often resolve. Pathologic Q waves reduce heart transplant use but do not impact graft survival.
Area of Science:
- Cardiology
- Transplantation Medicine
- Critical Care Medicine
Background:
- Electrocardiogram (ECG) abnormalities are common in potential organ donors after brain death.
- The clinical significance and prognostic value of these ECG findings remain largely unknown.
Purpose of the Study:
- To determine the prevalence of ECG abnormalities in potential cardiac donors.
- To investigate the association of these abnormalities with cardiac dysfunction, heart transplantation (HT) utilization, and recipient outcomes.
Main Methods:
- A nationwide cohort of 4,333 potential cardiac organ donors was analyzed.
- ECGs were interpreted by blinded experts and repeated 24 ± 6 hours after initial assessment.
- Statistical regression models assessed associations with cardiac findings, HT use, and graft survival.
Main Results:
- Of 4,136 interpretable ECGs, 64% showed abnormalities, most commonly nonspecific St-T-wave changes, T-wave inversion, or prolonged QTc interval.
- Pathologic Q waves were the only significant predictor of donor heart nonuse (adjusted OR: 0.39).
- No ECG abnormalities were associated with graft survival at 1 year post-HT.
Conclusions:
- ECG abnormalities are prevalent in potential heart donors but frequently transient.
- Pathologic Q waves are linked to decreased likelihood of heart transplantation but do not negatively affect long-term graft survival.
Background:
Potential organ donors often exhibit abnormalities on electrocardiograms (ECGs) after brain death, but the physiological and prognostic significance of such abnormalities is unknown.
Objectives:
This study sought to characterize the prevalence of ECG abnormalities in a nationwide cohort of potential cardiac donors and their associations with cardiac dysfunction, use for heart transplantation (HT), and recipient outcomes.
Methods:
The Donor Heart Study enrolled 4,333 potential cardiac organ donors at 8 organ procurement organizations across the United States from 2015 to 2020. A blinded expert reviewer interpreted all ECGs, which were obtained once hemodynamic stability was achieved after brain death and were repeated 24 ± 6 hours later. ECG findings were summarized, and their associations with other cardiac diagnostic findings, use for HT, and graft survival were assessed using univariable and multivariable regression.
Results:
Initial ECGs were interpretable for 4,136 potential donors. Overall, 64% of ECGs were deemed clinically abnormal, most commonly as a result of a nonspecific St-T-wave abnormality (39%), T-wave inversion (19%), and/or QTc interval >500 ms (17%). Conduction abnormalities, ectopy, pathologic Q waves, and ST-segment elevations were less common (each present in ≤5% of donors) and resolved on repeat ECGs in most cases. Only pathological Q waves were significant predictors of donor heart nonuse (adjusted OR: 0.39; 95% CI: 0.29-0.53), and none were associated with graft survival at 1 year post-HT.
Conclusions:
ECG abnormalities are common in potential heart donors but often resolve on serial testing. Pathologic Q waves are associated with a lower likelihood of use for HT, but they do not portend worse graft survival.
