Short-term heart transplant outcomes with heart organ procurement services

Novel heart procurement and preservation strategies have altered the organ procurement landscape. Heart organ procurement services (HOPS) have emerged as integrated businesses to procure and transport donor organs. While HOPS may provide convenience for transplant centers and increased access to novel donor heart preservation techniques, cost concerns remain. Clinical outcomes associated with HOPS have not been assessed.

We reviewed all adult heart transplants (HT) at Duke University Hospital from December 1, 2019 to May 2, 2025. The cohort was stratified by procurement team, HOPS or Tertiary Center Team (TCT). Short-term survival based on procurement strategy was compared using an inverse probability of treatment weighting (IPTW) Cox model. Additional post-HT outcomes including severe primary graft dysfunction (PGD) and length of stay (LOS) were also compared.

631 consecutive HT recipients were included. HOPS procured 153 (24.2%) organs and TCTs procured 478 (75.8%) organs. Donation after circulatory death donors were common in the cohort (30.6%) and more frequent among HOPS (69.3% vs 18.2%, p < 0.001). HOPS organs traveled further (median [Q1-Q3]: 410 [273 to 642] vs. 296 [118 to 422] miles, p < 0.001) with longer total ischemic time (median [Q1-Q3]: 5.9 [5.2 to 6.9] vs 3.8 [3.2 to 5.0] hours, p < 0.001). The likelihood of death following HT was lower in the HOPS group compared to the TCT group, though this difference was not statistically significant (HR: 0.84, 95% CI 0.47 to 1.50; p = 0.56). Similarly, there was no significant difference in severe PGD, length of stay, or treated rejection prior to discharge.

We found similar short-term survival and outcomes following HT for organs procured by HOPS and those procured by TCTs. Close monitoring of costs, organ utilization, and longer-term outcomes will be important as HOPS redefine organ procurement and transportation.