Donation after Circulatory Death in Heart Transplantation May Increase the Donor Pool by 20% in the U.S.

Purpose A shortage of donor hearts and high waiting list mortality have resulted in many transplant centers pursuing alternate strategies for utilization of adult donor hearts. Programs in Europe and Australia have demonstrated success with heart transplantation following donation after circulatory death (DCD); however, there are no active DCD heart transplant centers in the US. The aim of this study is to evaluate the potential impact of DCD donors on the US heart transplant donor pool. Methods The 2005-2017 UNOS/OPTN registry was retrospectively reviewed for all deceased donors. Potential donors who did not donate any organ for transplant were excluded. A multivariable logistic regression model for successful heart transplantation among donation after brain death (DBD) donors was generated using relevant demographic and clinical characteristics based on clinical experience. Covariates included donor age, gender, BMI, ethnicity, medical history, and ABO blood type. This model was then applied to Maastricht 3 DCD donors of other organs to identify suitable donors for heart transplantation. Results A total of 73,119 DBD donors and 12,148 DCD donors from 2005-2017 met inclusion criteria. Among the DBD donors, 30,422 (41.6%) were used for heart transplantation and 42,697 (58.4%) were not. Logistic regression identified independent predictors of successful heart transplantation. After applying this model to suitable DCD donors, an additional 5,271 potentially eligible heart transplant donors were identified during the study period, including 671 in 2016 alone. The supply of potential DCD hearts has increased annually (Figure). Conclusion DCD donation in heart transplantation has the potential to increase the pool of donor organs by approximately 20% per year in the United States. [ABSTRACT FROM AUTHOR]