Regional variation in donation after circulatory death heart allograft utilization

Oliver K Jawitz; Adam D Devore; Chetan B Patel; Jeffrey E Keenan; Carmelo A Milano; Jacob N Schroder

doi:10.1016/j.xjon.2024.07.004

Regional variation in donation after circulatory death heart allograft utilization

JTCVS Open. 2024 Jul 17:21:191-196. doi: 10.1016/j.xjon.2024.07.004. eCollection 2024 Oct.

Authors

Oliver K Jawitz¹, Adam D Devore², Chetan B Patel², Jeffrey E Keenan¹, Carmelo A Milano¹, Jacob N Schroder¹

Affiliations

¹ Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
² Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC.

Abstract

Objective: Randomized data support transplantation of hearts from donors after circulatory death. This may lead to a sizeable increase in the donor pool. Regional variations in donors after circulatory death heart use were examined to help elucidate barriers to donor pool expansion.

Methods: The United Network for Organ Sharing deceased donor dataset was queried for adult (age ≥ 18 years) donors after circulatory death donors of at least 1 organ between January 2020 and December 2023. Donors were stratified by the extent their respective cardiac allografts progressed through the donation process. United Network for Organ Sharing region-level use rates and annual trends were assessed.

Results: Of 17,239 adult donors after circulatory death donors who donated at least 1 organ for transplant during the study period, 1196 (9.4%) were heart donors. Regional donors after circulatory death heart donor pursuit rates ranged from 97% to 100%, consent attainment rates from 94% to 99%, and heart recovery rates from 5% to 10%. The transplantation rate of recovered organs ranged from 90% to 97%. Multivariable logistic regression demonstrated United Network for Organ Sharing region to be independently associated with donors after circulatory death heart use after controlling for baseline differences in donor risk.

Conclusions: Transplantation of donors after circulatory death heart allografts has increased in the United States since 2020, but the overall number of hearts procured and transplanted from donors after circulatory death donors remains low. The operational barriers to transplantation of donors after circulatory death hearts require further investigation. Further, significant regional variation exists regarding rates of progression of donors after circulatory death hearts through the donation process. Sharing of successful practices among Organ Procurement Organizations and transplant centers will facilitate maximal use of this new donor pool.

Keywords: donation after circulatory death; donor pool; heart transplantation; regional variation.