Can we safely expand the donation after circulatory death donor heart pool by extending the donor age limit?
Related Experiment Video
Updated: May 8, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Yeahwa Hong1, Nicholas R Hess1, Luke A Ziegler1
1Department of Cardiothoracic Surgery at the University of Pittsburgh Medical Center, Pittsburgh, Pa.
Insights
Donation after circulatory death heart transplantation using donors aged 40 years or more shows similar survival rates to younger donors. Careful selection is key to expanding the donor pool and improving outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Organ shortage remains a critical challenge in heart transplantation.
- Donation after circulatory death (DCD) offers a potential solution to expand the donor pool.
- The impact of donor age on DCD heart transplant outcomes requires further investigation.
Purpose of the Study:
- To evaluate the influence of donor age on outcomes after DCD heart transplantation.
- To compare survival rates between recipients of DCD allografts from older versus younger donors.
- To explore the role of recipient age in outcomes when using older DCD donors.
Main Methods:
- Analysis of adult recipients undergoing isolated DCD heart transplantation (2019-2023) from the UNOS registry.
- Stratification of donors into two groups: advanced age (≥40 years) and younger age (<40 years).
- Propensity score matching and subgroup analysis based on recipient age were performed to assess 90-day and 1-year survival.
Main Results:
- A total of 994 DCD heart transplants were analyzed; 17.1% involved donors aged ≥40 years.
- Recipients of DCD allografts from advanced-age donors demonstrated similar 90-day and 1-year survival compared to those from younger donors.
- Subgroup analysis revealed reduced 90-day survival in recipients aged ≥60 years who received allografts from advanced-age donors.
Conclusions:
- Appropriately selected DCD donors aged 40 years or more can yield comparable early post-transplant survival to younger donors.
- Utilizing older DCD donors, with careful recipient risk stratification, may help alleviate organ shortages.
- This approach offers a promising strategy to improve heart transplant accessibility without compromising early outcomes.
Objective:
This study evaluates the impact of donor age on outcomes following donation after circulatory death heart transplantation.
Methods:
The United Network for Organ Sharing registry was queried to analyze adult recipients who underwent isolated donation after circulatory heart transplantation from January 1, 2019, to September 30, 2023. The cohort was stratified into 2 groups according to donor age, where advanced donor age was defined as 40 years or more. Outcomes were 90-day and 1-year post-transplant survival. Propensity score matching was performed. Subgroup analysis was performed to evaluate the effects of recipient age on 90-day survival among the recipients with advanced-age donors.
Results:
A total of 994 recipients were included in the study period, and 161 patients (17.1%) received allografts from advanced-age donors. During the study period, the annual incidence of donation after circulatory heart transplantation with advanced-age donors substantially increased. The recipients with advanced-age donors had similar 90-day and 1-year post-transplant survivals compared with the recipients with younger donors. The comparable 90-day survival persisted in a propensity score-matched comparison. In the subgroup analysis among the recipients with advanced-age donors, the recipients aged 60 years or more had significantly reduced 90-day survival compared with the recipients aged less than 60 years.
Conclusions:
The use of appropriately selected donation after circulatory donors aged 40 years or more has similar survival compared with that of younger donors. With careful candidate risk stratification and selection, consideration of using donation after circulatory donors aged more than 40 years may further ameliorate ongoing organ shortage with comparable early post-transplant outcomes.
More Related Videos
09:54Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
06:40A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
