Impact of donation after circulatory death heart transplantation on waitlist outcomes and transplantation activity

Abstract

Introduction Donation after circulatory death (DCD) heart transplantation has been shown to have comparable outcomes to transplantation using brain death donors (DBDs). This study evaluates the impact of this alternative source of allografts on waitlist mortality and transplant volume. Methods We compared waitlist mortality and transplant rates in patients who were registered before (2019 period) and after we adopted DCD heart transplantation (2021 period). Results We identified 111 patients who were on the waiting list in 2019 and 77 patients who were registered during 2021. Total number of donor organ offers received in 2019 was 385 (178 unique donors) versus 3450 (1145 unique donors) in 2021. More than 40% of all donors in 2021 were DCDs. Waitlist mortality was comparable for patients in 2019 and 2021 (18/100 person‐years in 2019 vs. 26/100 person‐years in 2021, p = .49). The transplant rate was 67/100 person‐years in 2019 versus 207/100 person‐years in 2021 (p < .001). After adjusting for acuity status, gender, blood type, and weight, patients listed in 2021 had 2.08 times greater chance of transplantation compared to patients listed in 2019 (HR 2.08, 95% confidence interval [CI] 1.26–3.45, p = .004). Conclusions Use of DCD donor hearts significantly increased heart transplant rate in our institution.

Financial impact of donation after circulatory death heart transplantation: A single‐center analysis

“…To assess the impact of implementing DCD heart transplantation into our program we compared waitlist mortality and transplant rates in patients who were registered on the heart transplantation waiting list at our institution before and after we adopted DCD heart transplantation. 12 Waitlist mortality was comparable between these groups (18/100 person-years in 2019 vs. 26/100 person-years in 2021, P = .49). The transplant rate was 67/ 100 personyears before the DCD program versus 207/100 person-years after DCD was introduced (P < .001).…”

“…Adoption of DCD may increase the number of available donor organs for the program, allow heart transplant candidates to be transplanted earlier, avoid clinical deterioration while on the waiting list and decrease the cost associated with hospital admissions and other required procedures. To assess the impact of implementing DCD heart transplantation into our program we compared waitlist mortality and transplant rates in patients who were registered on the heart transplantation waiting list at our institution before and after we adopted DCD heart transplantation 12 . Waitlist mortality was comparable between these groups (18/100 person‐years in 2019 vs. 26/100 person‐years in 2021, P = .49).…”

“…1.26-3.45, P = .004). 12 These potential benefits of a DCD program are not accounted for in our analysis.…”

“…Recipients of DBD hearts had a total hospital length of stay of 27(14,38) days in comparison to 20 (16,38) days in DCD recipients (P = .91). Posttransplant length of stay was 14(12,27) days in DBD and 20 (16,37) days in DCD recipients (P = .09). Subgroup analysis of DCD recipients revealed 18 (15,34) days of post-transplant length of stay for TA-NRP and 25 (16,58) days for DP-NMP (P = .32).…”

Heart transplant donation after circulatory death: current status and implications

“…Most notably of patients with stable durable LVADs, those with ABO blood group O received these organs. From all reports the survival at 6 months is comparable to survival following traditional DBD at 91-95% [19][20][21][22]. Although there are trends to early right ventricular dysfunction and increased need for temporary MCS [14].…”