Donor heart refusal after circulatory death: An analysis of United Network for Organ Sharing refusal codesCentral MessagePerspective
Tyler M. Dann, BS,
Brianna L. Spencer, MD,
Spencer K. Wilhelm, MD,
Sarah K. Drake, MA, MLIS,
Robert H. Bartlett, MD,
Alvaro Rojas-Pena, MD,
Daniel H. Drake, MD
Affiliations
Tyler M. Dann, BS
Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich; Department of Surgery, Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, Mich
Brianna L. Spencer, MD
Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich; Department of Surgery, Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, Mich
Spencer K. Wilhelm, MD
Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich; Department of Surgery, Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, Mich
Sarah K. Drake, MA, MLIS
Information School, University of Wisconsin, Madison, Wis
Robert H. Bartlett, MD
Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich; Department of Surgery, Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, Mich
Alvaro Rojas-Pena, MD
Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich; Department of Surgery, Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, Mich; Department of Surgery, Section of Transplantation, University of Michigan Medical School, Ann Arbor, Mich
Daniel H. Drake, MD
Department of Surgery, Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, Mich; Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich; Address for reprints: Daniel H. Drake, MD, Department of Cardiac Surgery, Michigan Medicine, 1150 W Medical Center Dr, B560 MSRBII/SPC 5686, Ann Arbor, MI 48109.
Objective: Donor hearts procured after circulatory death (DCD) may significantly increase the number of hearts available for transplantation. The purpose of this study was to analyze current DCD and brain-dead donor (DBD) heart transplantation rates and characterize organ refusal using the most up-to-date United Network for Organ Sharing (UNOS) and Organ Procurement and Transplantation Network data. Methods: We analyzed UNOS and Organ Procurement and Transplantation Network DBD and DCD candidate, transplantation, and demographic data from 2020 through 2022 and 2022 refusal code data to characterize DCD heart use and refusal. Subanalyses were performed to characterize DCD donor demographics and regional transplantation rate variance. Results: DCD hearts were declined 3.37 times more often than DBD hearts. The most frequently used code for DCD refusal was neurologic function, related to concerns of a prolonged dying process and organ preservation. In 2022, 92% (1329/1452) of all DCD refusals were attributed to neurologic function. When compared with DBD, DCD donor hearts were more frequently declined as the result of prolonged warm ischemic time (odds ratio, 5.65; 95% confidence interval, 4.07-7.86) and other concerns over organ preservation (odds ratio, 4.06; 95% confidence interval, 3.33-4.94). Transplantation rate variation was observed between demographic groups and UNOS regions. DCD transplantation rates are currently experiencing second order polynomial growth. Conclusions: DCD donor hearts are declined more frequently than DBD. DCD heart refusals result from concerns over a prolonged dying process and organ preservation. Heart transplantation rates may be substantially improved by ex situ hemodynamic assessment, adoption of normothermic regional perfusion guidelines, and quality initiatives.
