Donation after circulatory death significantly reduces waitlist times while not changing post–heart transplant outcomes: A United Network for Organ Sharing Analysis

Abstract

ObjectiveRecently, several centers in the US have begun performing donation after circulatory death (DCD) heart transplants (HT) in adults. We sought to characterize the recent use of DCD HT, waitlist-time, and outcomes compared to donation after brain death (DBD). MethodsUsing the UNOS database, 10,402 adult (>18yo) HT recipients from January 2019-June 2022 were identified: 425(4%) were DCD and 9,977(96%) were DBD recipients. Post-transplant outcomes in matched and unmatched cohorts, and waitlist-times were compared between groups. ResultsDCD and DBD recipients had similar age [57y for both, p=0.791]. DCD recipients were more likely white (67% vs. 60%,p=0.002), on LVAD (40% vs. 32%,p<0.001) & listed as status 4-6 (60% vs. 24%,p<0.001); however, less likely to require inotropes (22% vs. 40%,p<0.001), & preoperative ECMO (0.9% vs. 6%,p<0.001). DCD donors were younger (29 vs. 32y,p<0.001), had less renal dysfunction (15% vs. 39%,p<0.001), diabetes (1.9% vs. 3.8%,p=0.050) or hypertension (9.9% vs. 16%,p=0.001). In matched & unmatched cohorts, early survival was similar (p=0.22). Adjusted waitlist-time was shorter in DCD group (21d vs. 31d,p<0.001) compared to DBD cohort and 5-fold shorter (DCD-22d vs DBD-115d,p<0.001) for candidates in status 4-6 which was 60% of DCD cohort. ConclusionsThe community is using DCD mostly for those recipients who are expected to have extended wait list times (e.g., Durable LVADs, Status >4). DCD recipients had similar post-transplant early survival, and shorter adjusted waitlist-time compared to DBD group. Given this early success, efforts should be made to expand the donor pool using DCD, especially for traditionally disadvantaged recipients on the waitlist.