Impact of Donation After Circulatory Death on Waitlist Duration and Early Outcomes in Heart Transplantation for Patients With Durable Mechanical Circulatory Support

Abstract Objective While heart transplantation primarily relies on donors after brain death, the use of donors after circulatory death is increasing to address donor shortages. Although favourable outcomes with donation after circulatory death (DCD) have been reported, its safety in patients bridged with durable mechanical circulatory support (MCS) remains uncertain. Design Using the United Network for Organ Sharing database, we identified adult recipients supported with durable MCS who underwent isolated primary heart transplantation between 2019 and 2023. Outcomes were compared between recipients of hearts from donors after brain death and donors after circulatory death. Results Among 14 881 heart transplants, 3681 patients were supported with durable MCS, comprising 3374 (91.7%) recipients from donors after brain death and 307 (8.3%) from donors after circulatory death. Compared with recipients of hearts from donors after brain death, those receiving hearts from donors after circulatory death were more often male, had higher body mass index, lower ABO blood group compatibility, fewer pretransplant infections, less extracorporeal membrane oxygenation use, longer ischaemic times (3.5 vs 5.5 hours, P < .05), and shorter waitlist times (404.4 vs 336.9, P < .05). Survival was similar between groups (90.9% vs 93.2% at 6 months, 89.0% vs 90.2% at 1 year; P = .946). Cause of death and other adverse events were also comparable. Conclusions Utilizing DCD donors significantly reduces waitlist duration for patients with durable MCS. Although early post-transplant survival was statistically stable, definitive conclusions regarding survival equivalence involve several limitations. Further larger comparative studies with comprehensive donor characteristics are strictly required to evaluate the safety profile of DCD hearts in this high-risk recipient population.