Heart transplant from donors after circulatory death shows positive outcomes

Adult donation after circulatory death (DCD) for heart transplantation (HT) presents favourable early outcomes and promises an increase in adult HT volumes with use of DCD donors, a US study has shown.

Between January 2020 and February 2021, adult DCD donors were identified using the United Network for Organ Sharing registry and compared based on their use for HT. The authors used Cox regression analysis and propensity matching to compare adult DCD-HTs with available post-HT outcomes data with contemporary adult donation after brain death (DBD)-HTs during the study period.

One hundred thirty-six of the 3,611 adult DCD donors referred during the study period were used for HT; these donors were younger (median age 29 years), mostly male (90 percent), and had blood type O (79 percent).

No significant difference between DCD-HT (n=127) and DBD-HT (n=2,961) was noted in 30-day or 6-month mortality, primary graft failure up to 30 days, or other outcomes such as in-hospital stroke, pacemaker insertion, haemodialysis, and post-HT length of hospital stay. Propensity-matched DCD-HT and DBD-HT cohorts showed similar results.

The number of potential adult DCD donors referred had markedly increased from 871 in 2010 to 3,045 in 2020. Widespread adoption of DCD-HT could lead to about 300 additional adult HTs in the US annually.

“A shortage of DBD donors for HT persists,” the authors said. “Recent improvements in organ procurement from DCD donors and promising early results … from Europe and Australia have renewed interest in DCD-HT.”