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Appraisal of Donation After Circulatory Death: How Far Could We Expand the Heart Donor Pool?

Authors :
Alejandro Suarez-Pierre
John Iguidbashian
Christina Stuart
Robert W. King
Jake Cotton
Adam M. Carroll
Joseph C. Cleveland
David A. Fullerton
Jay D. Pal
Source :
The Annals of Thoracic Surgery. 114:676-682
Publication Year :
2022
Publisher :
Elsevier BV, 2022.

Abstract

the incidence of organ donation after circulatory death (DCD) is increasing; however, heart use has lagged behind other solid organs. Ex vivo perfusion devices are under United States Food and Drug Administration review for use in DCD heart recovery. This study sought to measure the potential increase in the donor pool if DCD heart donation becomes widely adopted.DCD donor data were obtained from Organ Procurement and Transplantation Network database. Selection criteria included donor age 18 to 49 years, donors meeting Maastricht III criteria, warm ischemia time ≤30 minutes, and donation between 2015 and 2020. Exclusion criteria were coronary disease, prior myocardial infarction, ejection fraction0.50, significant valve disease, bacteremia, pulmonary capillary wedge pressure15 mm Hg, and history of HIV/hepatitis C virus infections.There were 12 813 DCD donors during this period, of which 3528 met study criteria, and 70 hearts (2%) were transplanted. The use of DCD hearts would represent an additional 48 heart transplants per month, which corresponds to a 21% (3458 of 16 521) increase across the country. Median warm ischemia was 23 minutes, with no difference between hearts that were or were not transplanted (23 vs 22.5 minutes, P = .97). The frequency with which other organs were successfully transplanted was kidney, 92%; liver, 44%; lung, 7%; intestine, 0%; and pancreas, 2%.Wide adoption of DCD heart transplantation could yield a substantial increase in the donor pool size, with approximately 580 additional organs being available each year across the United States. This would represent the largest increase in the donor pool in the modern era of heart transplantation.

Details

ISSN :
00034975
Volume :
114
Database :
OpenAIRE
Journal :
The Annals of Thoracic Surgery
Accession number :
edsair.doi.dedup.....f67a7fe09c2a1f173159938c0458785b
Full Text :
https://doi.org/10.1016/j.athoracsur.2022.01.042