Characteristics, Trends, and Outcomes of Heart Donation After Circulatory Death: An Early Analysis of the United...

Area of Science:

• Cardiology
• Transplantation Surgery
• Organ Donation Research

Background:

• Heart transplantation (HTx) is severely limited by donor organ scarcity.
• Donation after circulatory death (DCD) presents a viable alternative to traditional donation after brain death (DBD).
• Limited data exists on HTx outcomes using DCD donors, especially in the United States.

Purpose of the Study:

• To evaluate and compare heart transplantation outcomes between donation after brain death (DBD) and donation after circulatory death (DCD) donors.
• To analyze the safety and efficacy of DCD type III and DCD type IV donors for heart transplantation.
• To assess the impact of different procurement methods (DPP vs. NRP) for DCD type III donors.

Main Methods:

• Analysis of the UNOS thoracic database for adult, isolated, first-time orthotopic heart transplant recipients from 2019-2023.
• Stratification of recipients into three groups: DBD, DCD III, and DCD IV.
• Subgroup analysis of DCD III donors based on direct procurement and perfusion (DPP) or normothermic regional perfusion (NRP).

Main Results:

• A cohort of 14,035 HTx recipients was analyzed (DBD 86.5%, DCD III 6.9%, DCD IV 6.5%).
• DCD III recipients showed a higher incidence of postoperative dialysis; however, all groups had similar rates of stroke, rejection, and mortality.
• Procurement methods for DCD III donors (DPP vs. NRP) resulted in comparable survival rates.

Conclusions:

• Both DCD type III and IV heart transplants demonstrate comparable morbidity and survival rates to standard DBD donors.
• Despite an increased need for postoperative dialysis in DCD III recipients, DCD donation is a safe strategy to expand the donor pool in the US.
• These findings support the increased utilization of DCD donors to address the critical shortage of organs for heart transplantation.