The Impact of DCD Heart Transplantation on the Waiting List: A Single Centre Experience

Abstract

Purpose Heart transplantation from donation after circulatory determined death (DCD) has been practiced at our institution since March 2015 and has markedly increased our transplant activity. In this observational study , we explored the impact of DCD heart transplantation on waiting time for heart transplantation, need for mechanical circulatory support and waiting list mortality. Methods We interrogated our local transplant database for all patients listed for heart transplantation to include a period from March 2012 to March 2018. The first era (pre-DCD) included all patients listed in the 3 years before the introduction of DCD and the second era (DCD) included all patients listed in the 3 years after the introduction of DCD. To account for variances in the urgency listing process over the period, analyses were performed on cumulative waiting times. Results The introduction of DCD heart transplantation was associated with increased heart transplant numbers, compared with the preceding three years. There was a significant increased probability of being transplanted on the waiting list in the DCD period compared with the pre-DCD period. The waiting list mortality rate (deaths per 100 patient-years) was similar for the two periods, suggesting that the patients had a similar risk profile. There was a significant reduction in mean waiting time associated with a significant reduction in death/need for MCS on the waiting list in the DCD era. Competing risk analysis was performed to compare time to transplant and death whilst on the waiting list in the pre-DCD vs the DCD era (transplant, p Conclusion In the three years after introduction of DCD heart transplantation, we have seen an increase in heart transplant activity and a reduction in the waiting time for heart transplantation. It appears that DCD heart transplantation may have the potential to reduce waiting list mortality and the need for mechanical circulatory support by increasing the pool of donor hearts that are available for transplantation.