Outcomes of Multiorgan Heart Transplant Between Donation After Circulatory Death and Brain Death

Area of Science:

• Cardiology
• Transplant Surgery
• Organ Donation

Background:

• Limited data exists on outcomes for multiorgan transplants utilizing donation after circulatory death (DCD) organs, particularly those including heart transplants.
• Donation after brain death (DBD) remains the predominant method for organ procurement.

Purpose of the Study:

• To compare the overall survival outcomes between multiorgan transplants from DCD donors and DBD donors.
• To specifically analyze survival rates in combined heart-kidney transplants from both DCD and DBD donors.

Main Methods:

• Utilized the United Network for Organ Sharing (UNOS) Database to identify heart transplant recipients who also received a kidney, liver, or lung between 2019 and June 2023.
• Compared patient characteristics, pre-transplant status, and survival outcomes between DBD and DCD multiorgan transplant groups.
• Analyzed survival data for unmatched and matched cohorts, with a focus on heart-kidney transplants.

Main Results:

• A total of 1,844 DBD and 91 DCD multiorgan transplants were identified, with heart-kidney being the most common combination.
• DBD recipients were more likely to be listed at a higher status and require ICU care pre-transplant.
• Despite longer ischemia times in the DCD group, overall unmatched survival did not significantly differ between DBD and DCD multiorgan transplants.
• Survival rates for both unmatched and matched heart-kidney transplants were comparable between DBD and DCD donors.

Conclusions:

• Current data on DCD multiorgan transplant outcomes, especially those involving the heart, remain scarce.
• Available evidence suggests that overall survival following DCD multiorgan transplantation is comparable to that of DBD multiorgan transplantation.
• Further research is warranted to expand the understanding of DCD multiorgan transplant outcomes.