Superior Waitlist Outcomes Among Patients Listed for Donation After Circulatory Death Heart Transplantation

Abstract

Background: Recent advances in heart procurement techniques have facilitated the utilization of hearts obtained after circulatory death. However, discerning the population that stands to benefit most requires an understanding of waitlist outcomes.

Objectives: The objective of this study was to evaluate waitlist and post-transplant outcomes among patients listed for donation after circulatory death (DCD) hearts in the United States, stratified by listing status.

Methods: The UNOS (United Network for Organ Sharing) database was queried for all adult patients waitlisted for isolated heart transplantation between October 2018 and June 2024. Patients were stratified by approval for donation after brain death vs DCD hearts. DCD patients were subdivided into those who were DCD candidates at time of listing or later during their waitlist period. Waitlist and post-transplant outcomes were compared using Fine & Gray and Kaplan-Meier analyses.

Results: A total of 24,970 patients were identified; of these, 8,191 (33%) were listed as DCD candidates. DCD status 2, 3, 4, and 6 patients were more likely to be transplanted and less likely to die on the waitlist. There were no differences in post-transplant survival in any group. Receipt of a DCD heart was not predictive of mortality. Patients initially listed as DCD candidates were significantly more likely to be transplanted than those who became DCD candidates later during their waitlist course.

Conclusions: With exception of status 1, patients waitlisted for DCD hearts experience shorter waitlist duration, improved rates of transplantation, and comparable long-term survival with donation after brain death recipients.

Keywords: United Network for Organ Sharing; donation after brain death; donation after circulatory death; heart transplantation; waitlist outcomes.