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A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Utilization of Hearts Donated After Circulatory Death Improves All-Cause Survival in Candidates With Durable Left
Yeahwa Hong1,2,3, Umar Nasim1,3, Ander Dorken-Gallastegi1,3
1From the Department of Surgery, University of Pittsburgh Medical Center Pittsburgh, Pittsburgh, Pennsylvania.
Insights
Accepting donation after circulatory death (DCD) heart offers improves outcomes for durable left ventricular assist device (DLVAD) candidates. This approach increases transplant rates and survival, while reducing delisting risks for patients awaiting heart transplants.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Policy
Background:
- Heart transplantation policies changed in 2018, and donation after circulatory death (DCD) heart transplantation was introduced in 2019.
- Candidates with durable left ventricular assist devices (DLVADs) face longer wait times and poorer outcomes under the current system.
Purpose of the Study:
- To evaluate the impact of DCD heart utilization on waitlist outcomes for DLVAD candidates.
- To assess the association between DCD heart acceptance and transplantation rates, delisting, and survival.
Main Methods:
- Utilized the United Network for Organ Sharing (UNOS) registry for adult DLVAD candidates listed between December 1, 2019, and March 31, 2023.
- Stratified candidates based on approval to accept DCD donor offers.
- Analyzed 2-year cumulative incidences of transplantation, delisting (due to death or deterioration), and all-cause survival.
Main Results:
- Of 2,993 candidates, 487 (16.3%) accepted DCD offers.
- DCD acceptance was linked to a significantly lower risk of delisting.
- DCD acceptance correlated with a higher likelihood of transplantation and improved all-cause survival.
Conclusions:
- DCD heart utilization significantly improves outcomes for DLVAD candidates.
- Accepting DCD offers expands access to heart transplantation and enhances survival.
- The benefits of DCD heart utilization are evident even after multivariable analysis.
Abstract:
Heart transplantation practices have evolved significantly following the 2018 heart allocation policy changes and the introduction of donation after circulatory death (DCD) heart transplantation in 2019. Under the new system, candidates supported with durable left ventricular assist devices (DLVADs) experience longer waitlist times with worse outcomes. This study evaluates the impact of DCD heart utilization on waitlist outcomes among DLVAD candidates using the United Network for Organ Sharing (UNOS) registry. Adult candidates with DLVADs listed for isolated heart transplantation from December 1, 2019, to March 31, 2023, with a 2 year follow-up period extending to March 31, 2025. Candidates were stratified by approval status to accept DCD donor offers. The outcomes were 2 year cumulative incidences of transplantation, delisting due to death or clinical deterioration, and all-cause survival from the time of initial waitlisting. Among 2,993 candidates, 487 (16.3%) were approved to accept DCD donor offers. Approval for DCD donor offers was associated with a significantly lower risk of delisting, a higher likelihood of transplantation, and improved all-cause survival. Moreover, this survival improvement persisted in the multivariable Cox regression. These findings highlight the growing use and clinical value of DCD heart utilization in expanding access to transplantation and improving outcomes in DLVAD candidates awaiting transplantation.
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