Donors after Circulatory Death at the Medical College of Wisconsin and Potential for Increased Volume in Cardiac Transplantation

Abstract

Purpose The purpose of this study is to investigate the potential donor pool expansion that could occur through implementing a strategy for donors after circulatory death (DCD) heart transplantation. Methods A retrospective review of the Wisconsin Donor Network Organ Procurement (WIDN OPO) database between July 1, 2015 and June 30, 2017 was completed. The DCD population (n = 54) was stratified between high, moderate, and low risk via point analysis, based on previously published risk assessment tools. High risk features included advanced age, prolonged warm ischemic time or cardiopulmonary resuscitation, evidence of myocardial dysfunction, or active infection. Potential donors with prior cardiac history, mechanical circulatory support, age greater than 60, or active malignancy were excluded. For DCD donors with incomplete cardiac data, we assumed the percentage of normal cardiac function and biomarkers to resemble donors after brain death. Results Over two years the WIDN OPO had a total of 499 solid organ transplants from 172 donors, with 54 DCD referrals, 46 DCD going to transplant, and 15 local to Froedtert Hospital. Of the 54 DCD referrals, 28% (n = 15) had a complete cardiac evaluation with two donors falling into moderate risk category. Seventy-two percent (n = 39) of DCD donors did not have complete cardiac data prior to donation, and risk stratification of remaining variables revealed 35% low risk (n = 19), 31% moderate risk (n = 11), and 18% high risk (n = 10). Given 87% of brain death donors have normal echocadiograms and cardiac biomarkers, and applying that to the DCD donor population with incomplete cardiac data, 28% (n = 14) and 16% (n = 9) fell into the low and moderate risk categories respectively. Conclusion Instituting a DCD program for the WIDN OPO may yield a 21% increase, or an additional 19 heart transplants categorized as low risk based on traditional high risk features.