Waiting list mortality and the potential of donation after circulatory death heart transplantations in the Netherlands

Abstract

Background With more patients qualifying for heart transplantation (HT) and fewer hearts being transplanted, it is vital to look for other options. To date, only organs from brain-dead donors have been used for HT in the Netherlands. We investigated waiting list mortality in all Dutch HT centres and the potential of donation after circulatory death (DCD) HT in the Netherlands. Methods Two different cohorts were evaluated. One cohort was defined as patients who were newly listed or were already on the waiting list for HT between January 2013 and December 2017. Follow-up continued until September 2018 and waiting list mortality was calculated. A second cohort of all DCD donors in the Netherlands (lung, liver, kidney and pancreas) between January 2013 and December 2017 was used to calculate the potential of DCD HT. Results Out of 395 patients on the waiting list for HT, 196 (50%) received transplants after a median waiting time of 2.6 years. In total, 15% died while on the waiting list before a suitable donor heart became available. We identified 1006 DCD donors. After applying exclusion criteria and an age limit of 50 years, 122 potential heart donors remained. This number increased to 220 when the age limit was extended to 57 years. Conclusion Waiting list mortality in the Netherlands is high. HT using organs from DCD donors has great potential in the Netherlands and could lead to a reduction in waiting list mortality. Cardiac screening will eventually determine the true potential.

Atrioventricular Block Necessitating Chronic Ventricular Pacing After Tricuspid Valve Surgery in Patients With a Systemic Right Ventricle: Long-Term Follow-Up

“…The described cohort had high mortality of 25% at 10 years of follow-up and 52% reached the composite endpoint of mortality, VAD implantation, or progressive heart failure requiring CRT. No patients underwent heart transplantation, reflecting the scarceness of donor hearts in the Netherlands and the poor eligibility of these patients with complex anatomy and numerous thoracotomies ( 29 ). Our findings are in line with the previously described cohort reporting late mortality rates of 15% at 6 years of follow-up after TV surgery in patients with sRV ( 15 ).…”

The first experience with sodium‐glucose cotransporter 2 inhibitor for the treatment of systemic right ventricular failure

“…20 Only about 40 heart transplantations have been performed in the Netherlands annually and this number has not significantly increased over the recent years. 20 Timely referral for transplantation and awareness of alternatives such as VAD is important. 18 However, prevention is better than cure and efforts to halt progression of sRV failure are pivotal.…”

“…Looking beyond pharmacological options for advanced sRV failure, we enter the domain of heart transplantation and ventricular assist device (VAD) therapy 18,19 . Although our patient is young without extracardiac comorbidities and is currently being screened for cardiac transplantation eligibility, donor hearts remain scarce and Dutch data report a high waiting list mortality (15% before a suitable donor becomes available) with a median waiting time of 2.6 years and only 50% of the eligible patients being transplanted in the period 2013–17 20 . Only about 40 heart transplantations have been performed in the Netherlands annually and this number has not significantly increased over the recent years 20 .…”

Renal Delivery of Pharmacologic Agents During Machine Perfusion to Prevent Ischaemia-Reperfusion Injury: From Murine Model to Clinical Trials

“…Regarding the classification of donation after circulatory death (DCD) donors, also referred to as nonheart-beating donors (NHBD) or death after cardiac death donors, it was regulated by the First International Workshop in Maastricht. First of all, DCD donation takes place after declaration of death based on cardiorespiratory criteria in contrast to DBD that required neurological criteria (16)(17)(18). In addition, while in DBD organs are perfused until the moment of preservation, with almost absent first warm ischemia time, organs from DCD donors underwent warm ischemia between circulatory arrest and the start of organ perfusion (Figure 1).…”