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Updated: Jan 15, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Managing Expectations of Prolonged Warm Ischemia Time: A Calculator to Predict Donation After Circulatory Death Donor
Yanik J Bababekov1,2,3, Carlos Goncalves3, Anna H Ha4,5
1Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA.
Insights
Predicting circulatory death in donation after cardiac death (DCD) donors is crucial. DonorNet data can forecast DCD progression, enabling timely perfusion strategies (PS) to minimize warm ischemia time (WIT).
Area of Science:
- Transplantation Medicine
- Organ Procurement
- Predictive Analytics in Healthcare
Background:
- Transplant teams require predictive tools to manage donation after cardiac death (DCD) offers.
- Anticipating prolonged warm ischemia time (WIT) allows for proactive deployment of perfusion strategies (PS).
Purpose of the Study:
- To develop a predictive model for DCD progression to circulatory death within 30 minutes post-withdrawal of life support treatment (WLST).
- To identify clinical variables from UNOS DonorNet that correlate with rapid DCD progression.
Main Methods:
- Retrospective review of adult Maastricht-III DCD cases from January 2016 to July 2024.
- Utilized logistic regression to assess the likelihood of DCD progression within 30 minutes after WLST.
- Trained and validated the model on separate datasets (40% training, 60% validation).
Main Results:
- Out of 350 assessed DCDs, 49% progressed within 30 minutes.
- Positive predictors of progression included higher potassium, sodium, BMI, and heart rate.
- Negative predictors included younger age, pupillary reflexes, corneal reflexes, and overbreathing the ventilator.
- The model demonstrated excellent discrimination (NPV 89%, PPV 88%).
Conclusions:
- UNOS DonorNet variables effectively predict progression to circulatory death within 30 minutes.
- Early identification of DCDs unlikely to progress rapidly can inform discussions on perfusion strategies (PS).
- Proactive PS discussion can mitigate the risk of 'dry runs' in DCD transplantation.
Background:
Transplant teams may be better prepared to entertain DCD offers with a priori prediction of prolonged warm ischemia time (WIT) and deploy perfusion strategies (PS) to mitigate the risk of WIT.
Methods:
All potential adult Maastricht-III DCDs in one Organ Procurement Organization from January 2016 to July 2024 were reviewed. Data were obtained from UNOS DonorNet. Cases with missing variables were excluded. The most recent clinical values prior to withdrawal of life support treatment (WLST) were utilized. Logistic regression assessed the likelihood of DCD progression within 30 min after WLST.
Results:
From a total of 748 potential DCDs, 350 were assessed after exclusion criteria. One hundred and seventy-one (49%) progressed within 30 min. Forty percent (n = 140) of the sample was used for training and 60% (n = 160) for validation. Potassium (OR: 3.01; 95% CI: [1.39, 6.5], p = 0.005), sodium (OR: 1.23; 95% CI: [1.01, 1.50], p = 0.036); body mass index (OR: 1.68; 95% CI: [1.39, 2.03], p = 0.0001) and heart rate (OR: 1.54; 95% CI: [1.24, 1.92], p = 0.0001) positively correlated with progression. Age (OR: 0.71; 95% CI: [0.58, 0.86], p = 0.0006); presence of pupillary reflexes (OR: 0.81; 95% CI:[0.68, 0.92], p = 0.007); presence of corneal reflexes (OR: 0.27; 95% CI: [0.22, 0.34], p = 0.001); and presence of overbreathing the ventilator (OR: 0.39; 95% CI: [0.32, 0.48], p = 0.001) negatively correlated with progression. Discrimination was excellent (NPV 89%; PPV 88%).
Conclusions:
DonorNet variables predict progression to circulatory death within 30 min. If there is an indication that a DCD will not progress within a 30-min threshold, then early discussion of PS may decrease the risk of a dry run.
