Files
Abstract
Heart transplantation remains the gold standard therapy for end-stage heart failure. Although the number of donors has increased in recent years, there continues to be a critical shortage of organs where demand significantly exceeds supply. The upward trend of available donors has been attributed to several factors. In recent years, there has been an increased availability of donors from drug overdoses and the acceptance of hepatitis C positive donors because of effective antiviral therapy. In addition to an increase in donors from these two groups, donation after circulatory death [DCD] has emerged as a potential solution to augment the donor pool alongside the traditional donation after brain death [DBD] pathway.
Unlike DBD organs, which allow for a beating heart retrieval, DCD donor hearts experience warm ischemic time that can impact heart functioning and recovery. The development of normothermic regional perfusion [NRP] and the recent FDA approval of the Transmedics Organ Care System [OCS] have revolutionized the process of heart retrieval for DCD donors. This literature review aimed to critically evaluate and compare the outcomes of heart transplantation between DBD and DCD donors, focusing on recipient survival, complications, and clinical outcomes, as well as some of the new technology being used in DCD procurements. By synthesizing existing evidence, this review aims to inform clinical practice and guide future research efforts aimed at optimizing heart transplant outcomes and addressing the persistent challenges in organ shortage.
The literature review revealed comparable survival outcomes across all studies analyzed. There were no significant differences in 30-day or one-year survival between DBD and DCD cohorts. Some studies revealed higher rates of extracorporeal membrane oxygenation [ECMO] requirements in DCD heart recipients, although these hearts demonstrated rapid recovery of function and the need for short-term ECMO did not negatively impact survival. Some studies also showed potentially higher rates of severe primary graft dysfunction in DCD hearts, again with similar rapid recovery. These findings suggest that further research may need to be done regarding the post-operative management of DCD hearts, as their requirements may differ from DBD hearts unaffected by warm ischemic time.