Impact of Extended Heart Recovery Distance on Transplant Outcome Under the Current Heart Allocation Policy

Area of Science:

• Cardiology
• Transplantation Surgery
• Organ Procurement

Background:

• Current heart transplant allocation prioritizes donors within 500 miles, aiming for <4-hour ischemia time.
• Limited data exist on outcomes for heart transplants from extended distance (ED) donors (>500 miles).
• Hypothesis: ED heart procurement offers comparable outcomes to standard distances due to improved preservation and perioperative care.

Purpose of the Study:

• To compare outcomes of heart transplants using brain-dead donors from extended distances (ED) versus standard distances (<500 miles).
• To evaluate the safety and efficacy of ED heart procurement in the context of current allocation policies.

Main Methods:

• Retrospective analysis of 11,704 isolated heart transplants from brain-dead donors (Oct 2018 - Mar 2023).
• Comparison between standard distance (control; n=10,324) and ED donors (n=1380).
• Propensity score matching (1380 pairs) used to control for baseline differences.

Main Results:

• ED donors were older and more likely female; ED recipients were older with lower rates of mechanical support.
• ED group had longer ischemia times (4.4 vs 3.3 hours) and higher machine perfusion use (9.6% vs 1.5%).
• One-year survival (93.1% vs 92.1%) and graft survival (92.8% vs 91.5%) were similar between groups; recovery distance did not impact mortality.

Conclusions:

• Heart transplantation from ED brain-dead donors is safe, yielding comparable survival to standard distance procurements.
• Extended organ preservation and perioperative care mitigate risks associated with longer ischemia times.
• Findings support re-evaluation of allocation policies to potentially include ED donors more broadly.