Outcomes following concomitant multiorgan heart transplantation from circulatory death donors: The United States experience

Abstract

BackgroundDonation after circulatory death (DCD) has reemerged as a method of expanding the donor heart pool. Given the high waitlist mortality of multiorgan heart candidates, we evaluated waitlist outcomes associated with willingness to consider DCD offers and post-transplant outcomes following DCD transplant for these candidates. MethodsUsing the United Network for Organ Sharing database, we identified adult multiorgan heart candidates and recipients between 1/1/2020 and 3/31/2023. Among candidates that met inclusion criteria, we compared the cumulative incidence of transplant, with waitlist death/deterioration as a competing risk, by willingness to consider DCD offers. Among recipients of DCD vs. brain death (DBD) transplants, we compared perioperative outcomes and post-transplant survival. ResultsOf 1,802 heart-kidney, 266 heart-liver, and 440 heart-lung candidates, 15.8%, 12.4% and 31.1%, respectively, were willing to consider DCD offers. On adjusted analysis, willingness to consider DCD offers was associated with higher likelihood of transplant for all multiorgan heart candidates and decreased likelihood of waitlist deterioration for heart-lung candidates. Of 1,100 heart-kidney, 173 heart-liver, and 159 heart-lung recipients, 5.4%, 2.3%, and 2.5%, respectively, received DCD organs. Recipients of DCD and DBD heart-kidney transplants had similar likelihood of perioperative outcomes and 1-year survival. All other DCD multiorgan heart recipients have survived to last follow-up. ConclusionsMultiorgan heart candidates who were willing to consider DCD offers had favorable waitlist outcomes, and heart-kidney recipients of DCD transplants had similar post-transplant outcomes to recipients of DBD transplants. We recommend the use of DCD organs to increase the donor pool for these high-risk candidates.