In early 2020, Vanderbilt’s heart transplant program was among the first in the country to begin performing transplants using hearts from donation after circulatory death (DCD) donors. Similar to DBD (donation after brain death) donors, DCD donors have sustained devastating, non-recoverable neurologic injury.
Unlike DBD donors, however, DCD donors don’t yet meet formal brain death criteria – as such, the methods that are used for withdrawal of donor life support and surgical retrieval of DCD versus DBD organs differs. Until recently, there have been limited data on clinical outcomes in recipients of DCD as compared to DBD heart transplants. A VUMC study published Oct. 2 in the Journal of the American College of Cardiology is the largest single-center report on this topic, finding no difference in one-year survival and other outcomes among these two groups of patients.
The study, led by Hasan Siddiqi, MD, MSCI, and Kelly Schlendorf, MD, MHS, of the Division of Cardiovascular Medicine, explored outcomes in 385 adult heart transplant recipients who underwent transplant at Vanderbilt between January 2020 and January 2023 — including 122 from DCD donors and 263 from DBD donors. In addition to showing similar one-year survival after transplant regardless of donor type, the study found that recipients of DCD versus DBD hearts demonstrated no differences in rates of hospital readmission, heart rejection or cardiac allograft vasculopathy, a complication of heart transplant characterized by narrowing of the coronary arteries that supply blood to the new heart.
“Our findings confirm that DCD hearts yield excellent early outcomes,” said Siddiqi, assistant professor of Medicine. “This is important because these hearts are significantly expanding the donor pool – helping to narrow the gap between organ supply and organ demand.”
In fact, since Vanderbilt’s heart transplant program started using DCD hearts, these organs now account for nearly 50% of the transplants that the program performs. According to Schlendorf, associate professor of Medicine and medical director the adult heart transplant program, “Our DCD experience is a great example of Vanderbilt continuing to push the envelope in heart transplantation. Needless to say, a lot of people deserve credit for this success story, especially our cardiac surgery and anesthesia colleagues, as well as the nurses on our team who work tirelessly to find good organ offers for the patients on our waitlist.”
“This paper is a landmark work that signals a new era for human heart transplantation,” added Ashish Shah, MD, professor and chair of Cardiac Surgery and an author of the paper. “Moreover, it reminds us all of the real importance of academic medical centers like Vanderbilt. This is really the only place in the world where this work could have been done — where the right group of people, particularly our tireless organ recovery teams, accomplished what most people thought was impossible on a huge scale. And it was only possible with the unwavering support of our senior-most leaders — Drs. Pinson and Balser — who instinctively understood the impact of this high-risk effort.”
John Trahanas, MD, assistant professor of Cardiac Surgery and an author of the paper added, “It’s been exciting to see so many different disciplines come together to participate in this cutting-edge innovation.”
Ongoing studies will explore longer term outcomes in DCD heart transplantation.