Nasher Nayeem, Rahimov Daler, Macmillan T Reese, Siddique Faizaan, Rame J Eduardo, Eisen Howard J, Alvarez Rene J, Rajagopal Keshava, Entwistle John W, Tchantchaleishvili Vakhtang
Department of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Clin Transplant. 2025 Aug;39(8):e70266. doi: 10.1111/ctr.70266.
The number of heart allografts obtained from donation after circulatory death (DCD) remains low, especially compared to donation after brain death (DBD). Our study aimed to identify factors associated with the underutilization of hearts in ideal donors.
Patient-level data were obtained from the United Network for Organ Sharing (UNOS) database for all adult deceased donors who underwent organ procurement and subsequent transplantation between January 2020 and December 2023. "Ideal" DCD donors were analyzed as a separate subset and compared with ideal DBD donors. Transplantation rates, along with associated factors, were assessed.
The rate of heart allograft utilization was 6.9% in DCD donors compared to 35.4% among DBD donors (p < 0.001). Subgroup analysis of ideal donors demonstrated that 41% of DCD donors were utilized for heart transplantation compared to 85% of DBD donors (p < 0.001). Multivariable logistic regression analysis for heart utilization demonstrated that interventions, including extracorporeal life support (odds ratio [OR] 7.48, 95% CI 4.72-12.35) and coronary angiography (OR 2.77, 95% CI 1.76-4.39), were independent predictors of utilization. There was no significant association with hypertension (OR 0.75, 95% CI 0.52-1.06), tobacco use (OR 0.71, 95% CI 0.47-1.06), or BMI (OR 0.99, 95% CI 0.97-1.01) in the ideal DCD donor. Regional variation in donor heart utilization rates was observed.
There remains a significant portion of ideal DCD donors whose hearts remain unutilized. Identifying and addressing factors related to underutilization may improve organ yield.
与脑死亡后捐赠（DBD）相比，循环死亡后捐赠（DCD）获得的心脏移植数量仍然较低。我们的研究旨在确定理想供体中心脏未充分利用的相关因素。
从器官共享联合网络（UNOS）数据库中获取了2020年1月至2023年12月期间所有接受器官获取及后续移植的成年已故供体的患者层面数据。“理想”的DCD供体作为一个单独的子集进行分析，并与理想的DBD供体进行比较。评估了移植率及相关因素。
DCD供体的心脏移植利用率为6.9%，而DBD供体为35.4%（p<0.001）。理想供体的亚组分析表明，41%的DCD供体心脏用于心脏移植，而DBD供体为85%（p<0.001）。心脏利用的多变量逻辑回归分析表明，包括体外生命支持（比值比[OR]7.48，95%可信区间4.72-12.35）和冠状动脉造影（OR 2.77，95%可信区间1.76-4.39）在内的干预措施是利用的独立预测因素。在理想的DCD供体中，与高血压（OR 0.75，95%可信区间0.52-1.06）、吸烟（OR 0.71，95%可信区间0.47-1.06）或体重指数（OR 0.99，95%可信区间0.97-1.01）无显著关联。观察到供体心脏利用率的区域差异。
仍有相当一部分理想的DCD供体心脏未被利用。识别和解决与未充分利用相关的因素可能会提高器官产量。
