Analysis of United Network for Organ Sharing Database: The US Experience With Donation After Circulatory Death for Pediatric Heart Transplantation

Abstract

Background

This study characterizes all donation after circulatory death (DCD) pediatric heart procurements and transplants performed in the United States before 2024.

Methods

We conducted a retrospective review of the United Network for Organ Sharing Database for all pediatric heart donors and recipients for transplants performed from January 1, 2004 to December 31, 2023. Propensity score matching was used to create more balanced groups for comparison between DCD and donation after brain death (DBD) donors.

Results

Since 2004, a total of 85 pediatric DCD hearts were procured and transplanted into adult or pediatric recipients, and 19 pediatric patients received DCD heart transplants. The majority of pediatric DCD heart procurements (57.6% [n = 49 of 85]) and transplants (52.6% [n = 10 of 19]) occurred in 2023. One year survival was 89.6% (95% confidence interval [CI] = 85.0-94.4) after DBD heart transplants and 84.3% (95% CI = 76.0-93.4) after DCD heart transplants (P = 0.20), and receipt of a pediatric DCD heart was not associated with an increased risk of mortality (hazard ratio [HR] = 1.68 [95% CI = 0.80-3.56], P = 0.17). Among DCD pediatric heart donors, no difference was observed in 1-year survival in normothermic regional perfusion (NRP) versus direct procurement with or without perfusion (DPP): NRP = 87.0% (95% CI = 74.2-99.9) versus DPP = 78.0% (95% CI = 65.3-93.2, P = 0.40), and receipt of a NRP heart was not significantly associated with an increased risk of mortality (HR = 0.59 [95% CI = 0.16-2.24], P = 0.44). Among the 19 pediatric recipients of a DCD heart, 9 were procured using NRP (47.4% [n = 9 of 19]).

Conclusions

Pediatric DCD is increasing for cardiac donors and pediatric heart transplant recipients. Heart transplantation using pediatric DCD donors demonstrates short-term survival outcomes comparable with those using pediatric DBD donors, with NRP emerging as an effective technique for pediatric DCD heart procurement.

Keywords

transplantation heart circulatory death brain death pediatric

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