Waitlist and Transplant Outcomes in Organ Donation After Circulatory Death

Abstract

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.

Longitudinal Trends in Donor and Recipient Risk Profile, and Clinical Outcomes, for Donation After Circulatory Death Heart Transplantation

“…To date, this expansion of DCD HT is not associated with worsened post-HT survival, which remains similar to survival after donation after brain death HT. 5 This finding must be interpreted with caution, in the context of our limited sample size, and inability to analyze post-HT outcomes from 2023 (where a further increase in status 2 recipients was noted). Further analysis, particularly in larger cohorts of UNOS status 1 and 2 recipients, is required.…”

Bridging the gap between in vitro and in vivo models: a way forward to clinical translation of mitochondrial transplantation in acute disease states

“…This includes ischemia during organ retrieval and during implantation in the recipient. More recently, the advent of organ donation after circulatory death (DCD), aimed at increasing the donor pool, generated a third period of WIT impacting the quality of some donated organs, including hearts [71]. In the heart, it is known that WITs longer than 10 min increase mitochondrial damage and compromise ETC activity, increase caspase 3 and 7, induce cardiomyocyte apoptosis, and decrease overall myocardial function and primary graft failure [72].…”

Circulatory Death and Organ Donation

“…With an enhanced understanding of the pathophysiology of the DCD and experience gained over the past three decades, KT from DCD donors has become routine. 2 In recent years, a marked increase in DCD donation rate has occurred in Spain (19.55 per million population (pmp), Belgium (12.82 pmp), Netherlands (10.02 pmp), United Kingdom (9.43 pmp), France (3.58 pmp) and China (1.29 pmp). 3…”