Heart donation and transplant recipient survival outcomes from deceased organ donors managed in hospital-based versus independent donor care units.

Abstract

Background: Despite growing prevalence, the impact of centralized deceased organ donor care on heart donation and transplant recipient outcomes remains unknown.

Methods: We conducted a retrospective study using Organ Procurement and Transplantation Network deceased donor and transplant recipient data. We included adult deceased organ donors after brain death managed in 21 U.S. regions with donor care units (DCUs) January 2019 - December 2022 and their heart recipients. The primary exposure was organ recovery in independent versus hospital-based DCUs. Outcomes included heart graft survival duration (primary) and incidence of heart donation.

Results: The cohort captured 9830 donors after brain death, 3302 in 10 independent DCUs (33.6%) and 1366 (13.9%) in 11 hospital-based DCUs (the remainder in hospitals). Unadjusted heart donation did not differ between independent and hospital-based DCUs (40.9% vs. 40.4%, p=0.75). In a logistic regression model including donor factors, odds of heart donation did not differ by DCU type (aOR 1.02, 95% CI 0.86-1.22). Among 3108 heart transplant recipients from cohort heart donors, restricted mean survival time 4 years after transplant was not different between hearts recovered in independent versus hospital-based DCUs (1292 days vs. 1276). In a Cox model including donor and recipient factors, adjusted hazards of graft failure were not different by DCU type (aHR 0.79, 95% CI 0.50-1.24).

Conclusions: Among deceased organ donors after brain death, heart donation and heart transplant survival did not vary between hospital-based and independent DCUs. Further work is needed to determine if DCU utilization increases the number of hearts available for transplant.