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Hearts from donors after circulatory death appear highly suitable for transplant

Journal of the American College of Cardiology
Reuters Health - 06/01/2022 - Results of transplants that use hearts from carefully selected adult donation after circulatory death (DCD) donors appear to be similar to those using hearts from donation after brain death (DBD) donors, at least with respect to early outcomes, researchers report.

Based on their analysis, published in the Journal of the American College of Cardiology, the authors estimate that if a transthoracic echocardiogram (to assess left ventricular ejection fraction) were performed for all potential DCD donors in the United States, broad acceptance and use of such hearts could translate into up to about 300 additional adult heart transplants annually.

"Three hundred additional donor hearts may seem like a small number, but considering that the total volume of adult heart transplantations in the U.S. annually is only about 2,800 to 3,000," 300 represents a substantial increase of at least 10%, corresponding author Dr. Shivank Madan of Montefiore Medical Center, in New York City, told Reuters Health by email.

It's important to note, he added, that the researchers used very strict donor criteria for their estimates and that the study took place during the COVID-19 pandemic, which disrupted transplant programs nationwide, so "the actual number may be much higher than 300 in the coming years."

The researchers note that although DCD donors have been used for liver, lung and kidney transplantations in the United States, "DCD donors were largely considered off-limits for adult (heart transplant) in the United States until very recently."

Using the United Network for Organ Sharing registry, the authors identified 3,611 adult potential DCD donors, of whom 136 were used for heart transplant. The latter were significantly younger on average (median age, 29), less likely to be female, more likely to have blood type O, and less likely to have diabetes, hypertension, or coronary artery disease.

More than 90% of the donors had died of either brain anoxia or head trauma.

Over a median follow-up of 6.1 months, estimated 30-day (0.8% vs. 3.3%) and six-month survival (5.4 vs. 7.6%) did not differ significantly for DCD and DBD recipients in the same registry, even after adjustment for several potential confounders.

Similarly, rates of primary graft failure, in-hospital stroke, pacemaker insertion, or hemodialysis did not differ significantly between the two cohorts.

In an accompanying editorial, Dr. Francis Pagani of the Department of Cardiac Surgery, University of Michigan, Ann Arbor, says the new paper "is an important summary of an early U.S. experience using DCD donors for heart transplantation and provides further data to support this approach as a crucial strategy to expand the donor heart pool."

He also highlights the lack of "important information on the procedures used for DCD heart procurement."

In an email to Reuters Health, Dr. Stephen Large, a consultant cardiothoracic surgeon at Royal Papworth Hospital, in Cambridge, UK, called the report "a great step forwards in the direction of the transplant world and society's acceptance of DCD heart transplantation."

"This fine work has added huge support to a welcome expansion of donor-heart availability," said Dr. Large, who was not involved in the study.

Dr. Kumud Dhital, program and surgical director for heart-lung transplantation at SPARSH Hospital, in Bangalore, India, told Reuters Health by email that "the study adds further clinical evidence for the continued and increased use of DCD hearts for clinical transplantation with excellent short- and medium-term outcomes."

Early results from DCD heart transplant programs in the United States "have been consistently good," said Dr. Dhital, who also was not involvd in the study.

"I am hopeful that more centres around the world will adopt DCD heart transplantation, which currently is largely limited due to the enormous cost of the heart perfusion device still necessary for this procedure," he added.

SOURCE: https://bit.ly/3FGNXAq Journal of the American College of Cardiology, online December 15, 2021.

By Scott Baltic

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