Characteristics, Trends, and Outcomes of Heart Donation After Circulatory Death: An Early Analysis of the United Network for Organ Sharing Database

Abstract

Heart transplantation (HTx) is greatly limited by organ shortage. To address this crisis, donation after circulatory death (DCD) is an emerging alternative to the traditional donation after brain death (DBD). Unfortunately, there is scarce data on HTx outcomes for this donation type, particularly within the United States; our investigation seeks to address this knowledge gap. As part of this study, the UNOS thoracic database was analyzed for first-time, adult, isolated orthotopic HTx recipients between 2019 and 2023. Patients were stratified into 3 groups: DBD, DCD III, and DCD IV. Further subgroup analysis for DCD III donors was conducted based on the procurement method, direct procurement and perfusion (DPP) or normothermic regional perfusion (NRP). After creating the sample cohort, a total of 14,035 HTx recipients were included in our analysis (DBD 86.5%, DCD III 6.9%, DCD IV 6.5%). There was an exponential increase in the number of DCD III cases and HTx centers that offer this donation type during the study period. DCD III recipients had a higher incidence of postoperative dialysis use; otherwise, all 3 groups shared similar rates of postoperative permanent pacemaker placement and stroke, acute rejection, and mortality. Within DCD III recipients, DPP and NRP procurement techniques had similar survival. To conclude, although DCD III was associated with an increased incidence of postoperative dialysis use, both DCD type III and IV had comparable morbidity and survival as the standard of care DBD donors. Overall, our investigation provides encouraging data to support DCD use as a safe option to increase the limited donor pool in the United States.