Heart transplants (HTs) taken from donors after circulatory death, as opposed to after brain death, are associated with positive patient outcomes, according to new data published in the Journal of the American Heart Association.
"Currently, heart transplantation in the United States primarily relies on donation after brain death (DBD) donors," wrote Shivank Madan, MD, MHA, with the division of cardiology at Montefiore Medical Center and Albert Einstein College of Medicine, and colleagues. "Development and ethical acceptance of brain death criteria was critical to the success of heart transplantation as a field, as it allowed minimization of organ hypoxia (heart is continuously perfused in the DBD donor until cross-clamp is applied during organ procurement) and permitted functional assessment of a potential donor heart before recovery. Donation after circulatory death (DCD) donors, on the other hand, may have severe brain injury, but do not fulfill the brain death criteria."
Madan et al. also noted that a substantial uptick in HT numbers would likely coincide with the widespread use and adoption of DCD donors.
Considering the ongoing shortage of DBD donors for HT, the group set out to examine donor and recipient characteristics, early outcomes, and potential impact of DCD donors for HT (DCD-HT) in the United States. The analysis included 3,611 DCD donors, and 136 were used for a HT.
Data was from the United Network for Organ Sharing database. Ninety percent of patients were men, and the median patient age was 29 years old.
The authors examined 2,961 adult DBD-HTs and found no significant difference in 30-day or six-month survival between recipients of DCD-HT and DBD-HT.
According to the authors, the number of potential adult DCD donors have increased significantly over the past 10 years, jumping from from 871 in 2010 to 3,045 in 2020.
The group also wrote that, even if only one half of the suitable DCD donors were to be used for HT, it could result in an annual increase of almost 300 additional adult HTs.
“These results should be reassuring and help to expand the practice of DCD-HT in the United States,” the authors wrote. “We also noted that a widespread adoption of HT from DCD donors in the United States could lead to approximately 300 additional adult HTs each year, and this should also help reduce the HT waitlist times. It is also important to mention that the current study included a period when large parts of United States were affected by the COVID-19 pandemic, resulting in severe restrictions and challenges for organ procurement organizations and HT programs.”
The group also explained that effective implementation of DCD-HT in the United States could have even a greater proportional impact on pediatric HTs, as younger donor hearts are inherently more resistant to ischemic injury.
Read the full study here.