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Published on: June 6, 2025
Donation After Circulatory Death in Pediatric Heart Transplantation
Sarah Dudley Grorud1, Michael D Porter2,3, Taufiek Konrad Rajab4
1Pediatric Cardiology, University of Virginia Children's Hospital, Charlottesville, Virginia, USA.
Insights
Pediatric heart transplants using donation after circulatory death (DCD) organs offer more frequent offers and similar waitlist survival compared to donation after brain death (DBD) organs. This strategy expands access to donor hearts without impacting early outcomes.
Area of Science:
- Pediatric Cardiology
- Transplantation Immunology
- Organ Donation
Background:
- Donation after circulatory death (DCD) is an emerging strategy in heart transplantation (HT).
- While successful in adults, pediatric DCD-HT is underutilized but gaining traction.
- DCD offers potential to improve waitlist outcomes and expand donor pool.
Purpose of the Study:
- To assess the impact of DCD listing on waitlist outcomes in pediatric heart transplantation.
- To evaluate graft survival and offer dynamics for pediatric candidates listed for DCD versus DBD organs.
- To determine if DCD listing affects waitlist mortality or post-transplant survival.
Main Methods:
- Utilized the OPTN/UNOS database for pediatric primary isolated HT candidates (Jan 2021-June 2024).
- Compared waitlist outcomes and offer dynamics based on DCD versus DBD listing.
- Employed multivariable regression to model offer frequency and compared 30-day survival between DCD and DBD recipients.
Main Results:
- DCD candidates (n=86) had higher clinical acuity than DBD candidates (n=2400).
- DCD listing significantly increased offer rate by 134% and shortened intervals between offers.
- Waitlist outcomes and 30-day post-transplant survival were similar between DCD and DBD groups.
Conclusions:
- Pediatric DCD listing increases offer frequency and shortens offer intervals.
- Waitlist survival is comparable despite higher acuity in DCD candidates.
- Broader adoption of pediatric DCD-HT can expand donor heart access without compromising early outcomes.
Purpose:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
