Heart donation and transplant recipient survival outcomes from deceased organ donors managed in hospital-based vs independent donor care units

BACKGROUND: Despite growing prevalence, the impact of centralized deceased organ donor care units on heart donation and transplant recipient outcomes remains unknown.

METHODS: We conducted a retrospective study using Organ Procurement and Transplantation Network deceased donor and transplant recipient data. We included adult deceased organ donors after brain death managed in 21 US regions with donor care units (DCUs) January 2019 to December 2022 and their heart recipients. The primary exposure was organ recovery in independent vs hospital-based DCUs. Outcomes included heart graft survival duration (primary) and incidence of heart donation.

RESULTS: The cohort captured 9,830 donors after brain death, 3,302 in 10 independent DCUs (33.6%), and 1,366 (13.9%) in 11 hospital-based DCUs (the remainder in hospitals). Unadjusted heart donation did not differ between independent and hospital-based DCUs (40.9% vs 40.4%, p = 0.75). In a logistic regression model including donor factors, odds of heart donation did not differ by DCU type (adjusted odds ratio [aOR] 1.02, 95% confidence interval [CI] 0.86-1.22). Among 3,108 heart transplant recipients from cohort heart donors, restricted mean survival time 4 years after transplant was not different between hearts recovered in independent vs hospital-based DCUs (1,292 vs 1,276 days). In a Cox model including donor and recipient factors, adjusted hazards of graft failure were not different by DCU type (adjusted hazard ratio [aHR] 0.79, 95% CI 0.50-1.24).

CONCLUSIONS: Among deceased organ donors after brain death, heart donation and heart transplant survival did not vary between hospital-based and independent DCUs. Further work is needed to determine if DCU utilization increases the number of hearts available for transplant.

National Institutes of Diabetes, Digestive, and Kidney Diseases

Felicia Y Ho, Xingmei Wang, Douglas E Schaubel, Mauer Biscotti III, Marisa Cevasco, Aditya G Parikh, Meeta P Kerlin, Jason D Christie, Peter P Reese, Emily A Vail