Donation After Circulatory Death in Pediatric Heart Transplantation

Donation after circulatory death (DCD) is an emerging heart transplantation (HT) strategy with improved waitlist and comparable post-transplant outcomes to donation after brain death (DBD) in adults. Pediatric DCD-HT is underutilized but gaining broader adoption. We assessed the impact of DCD listing on waitlist outcomes and graft survival in pediatric HT.

We queried the OPTN (Organ Procurement and Transplantation Network)/UNOS (United Network for Organ Sharing) database for all pediatric primary isolated HT candidates between January 2021 and June 2024. Waitlist outcomes were compared by final listing type to account for crossovers. Offer dynamics were assessed by average interval between offers stratified by OPTN/UNOS status. Multivariable regression modeled offer frequency as a function of DCD listing. We compared 30-day survival between recipients of DCD and DBD organs.

Among 2486 candidates, 86 were initially listed eligible for DCD and 2400 for DBD. DCD candidates had higher clinical acuity than DBD candidates. DCD listing was associated with significantly shorter intervals between offers across all statuses and increased offer rate by 134% (95% CI: 92%-186%). Waitlist outcomes did not differ significantly by final listing type. There was no difference in 30-day survival between DCD and DBD recipients.

DCD listing in pediatric HT is associated with a shorter interval between offers and more frequent offers. Waitlist survival was similar between groups despite DCD candidates being sicker at listing. There was no difference in 30-day survival between DCD and DBD recipients. These findings suggest that broader adoption of pediatric DCD-HT can expand access to donor hearts without compromising early post-transplant outcomes.