Early Outcomes of Heart Transplantation Using Donation After Circulatory Death Donors in the United States

Kwon, Jennie H.; Ghannam, Alexander D; Shorbaji, Khaled; Welch, Brett; Hashmi, Zubair A.; Tedford, Ryan J.; Kilic, Arman

doi:10.1161/circheartfailure.122.009844

Cited by 39 publications

(34 citation statements)

References 27 publications

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“…31,[38][39][40] However, NRP is increasingly used in DCD heart and abdominal organ procurements in the United States and has shown favorable utilization and graft outcomes for both kidney and liver transplantations compared with static cold storage. 13,41,42 NRP was also found to be safe for DCD lung retrieval in a large institutional series. 43 While no studies have demonstrated the superiority of NRP over EVP for DCD heart transplantation, this procurement strategy for DCD hearts is associated with improved utilization and posttransplant outcomes for concomitantly procured abdominal organs.…”

Section: Discussionmentioning

confidence: 74%

“…Moreover, encouraging international outcomes with DCD heart transplantation has spurred the utilization of these organs by almost one-fifth of US centers since 2019. 13 This analysis summarized waitlist and transplant outcomes with DCD kidney, liver, lung, and heart transplantation in the United States.…”

Section: Discussionmentioning

confidence: 99%

“…Despite initial concerns for warm ischemic injury with DCD leading to increased graft dysfunction after transplant, survival among recipients of DCD kidney, liver, lung, and heart transplantation is comparable to those receiving organ donation after brain death (DBD) 10–13 . In addition, improvements in donor/recipient selection and procurement and preservation strategies have contributed to improving survival with DCD kidney, liver, and lung transplantation over time 14–17 .…”

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confidence: 99%

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Waitlist and Transplant Outcomes in Organ Donation After Circulatory Death

et al. 2023

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Objectives: To summarize waitlist and transplant outcomes in kidney, liver, lung, and heart transplantation using organ donation after circulatory death (DCD). Background: DCD has expanded the donor pool for solid organ transplantation, most recently for heart transplantation. Methods: The United Network for Organ Sharing registry was used to identify adult transplant candidates and recipients in the most recent allocation policy eras for kidney, liver, lung, and heart transplantation. Transplant candidates and recipients were grouped by acceptance criteria for DCD versus brain-dead donors [donation after brain death (DBD)] only and DCD versus DBD transplant, respectively. Propensity matching and competingrisks regression was used to model waitlist outcomes. Survival was modeled using propensity matching and Kaplan-Meier and Cox regression analysis. Results: DCD transplant volumes have increased significantly across all organs. Liver candidates listed for DCD organs were more likely to undergo transplantation compared with propensity-matched candidates listed for DBD only, and heart and liver transplant candidates listed for DCD were less likely to experience death or clinical deterioration requiring waitlist inactivation. Propensity-matched DCD recipients demonstrated an increased mortality risk up to 5 years after liver and kidney transplantation and up to 3 years after lung transplantation compared with DBD. There was no difference in 1-year mortality between DCD and DBD heart transplantation. Conclusions: DCD continues to expand access to transplantation and improves waitlist outcomes for liver and heart transplant candidates. Despite an increased risk for mortality with DCD kidney, liver, and lung transplantation, survival with DCD transplant remains acceptable.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Waitlist and Transplant Outcomes in Organ Donation After Circulatory Death

et al. 2023

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“…Success rates in heart transplantation after DCDD are improving rapidly. 36 Last, one might suggest that our proposal is arbitrary. Why not just declare someone dead when they have permanently lost consciousness?…”

Section: Potential Counterargumentsmentioning

confidence: 99%

Rethinking Brain Death—Why “Dead Enough” Is Not Good Enough

Sulmasy

Decock

2023

Neurology

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The emergence of cases of so-called “chronic brain death” appear to undermine the bio-philosophical justification of brain death as true death, which was grounded in the idea that death entails the loss of integration of the organism. Severely neurologically damaged patients who can persist for years with proper support appear to be integrated organisms and common sense suggests that they are not dead. We argue, however, that mere integration is not enough for an organism to be alive, but that living beings must be substantially self-integrating (i.e., a living organism must itself be the primary source of its integration and not an external agent such as a scientist or physician). We propose that irreversible apnea and unresponsiveness are necessary but not sufficient to judge that a human being has lost sufficient capacity for self-integration to be considered dead. To be declared dead, the patient must also irrevocably have lost either (1) cardiac function or (2) cerebro-somatic homeostatic control. Even if such bodies can be maintained with sufficient technological support, one may reasonably judge that the locus of integration effectively has passed from the patient to the treatment team. While organs and cells may be alive, one may justifiably declare that there is no longer a substantially autonomous, whole, living human organism. This bio-philosophical conception of death implies that the notion of brain death remains viable, but that additional testing will be required to ensure that the individual is truly brain dead by virtue of having irrevocably lost not only the capacity for spontaneous respiration and conscious responsiveness, but also the capacity for cerebro-somatic homeostatic control.

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“…[1][2][3] The opioid epidemic has led to an expanded donor pool, 4 and additional expansion has occurred with the development of protocols for the use of hepatitis C positive organs 5 and donation after cardiac death (DCD) hearts. 6 Yet, organ preservation still remains a major issue limiting supply and geographic reach of donor hearts, and innovative technologies are emerging to address this issue.…”

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confidence: 99%