Donation after circulatory death transplantation alleviates waitlist time for hard-to-transplant cardiac recipients.

BACKGROUND

Donation after circulatory death (DCD) can increase the cardiac transplant donor pool and decrease waitlist time. Patients with certain characteristics may be more difficult to match with appropriate donors. This study aimed to evaluate the impact of DCD heart donations on these candidates.

METHODS

This was a retrospective study using the Scientific Registry of Transplant Recipients database including adult patients listed for heart transplant between 11/1/2018 and 3/2/2024. The cohort was divided into pre-DCD era, early DCD era, and contemporary DCD era. The following factors were used to classify candidates as difficult to transplant: height or weight greater than 2 SD above the average, blood type O, congenital heart disease, left ventricular assist device (LVAD), and status 4, 5, or 6.

RESULTS

Findings revealed a decrease in median waitlist time from 2.8 months in the pre-DCD era to 1.6 months in the contemporary era and an increase in the transplantation rate from 65% to 73%. However, factors such as type O blood, presence of durable LVAD, and listing status significantly correlated with lower transplant likelihood across eras. DCD transplant recipients faced longer waitlist times compared to donation after brain death (DBD) counterparts in the early DCD era, while this disparity diminished in the contemporary era.

CONCLUSIONS

Early DCD utilization alleviated the prolonged waiting times seen by hard-to-transplant recipients. As experience with DCD hearts increased, DCD hearts augmented the donor pool, reducing waitlist time in across all cohorts.