How Donation After Cardiac Death Heart Transplants Are Benefitting Care Centers

A Massachusetts General Hospital investigator explains how the innovative DCD practice addresses both waitlist issues and transplant center's capabilities.

A relatively new method of evaluating would-be donor hearts may revolutionize the capability of transplant centers helping patients in dire need while on the US waitlist.

At institutions including Massachusetts General Hospital (MGH), it’s already making a difference in vital heart transplant resourcing and strategy.

In a presentation at the International Society for Heart & Lung Transplant (ISHLT) 2022 Meeting this month, MGH Outcomes in Cardiac Surgery Research Fellow Stanley B. Wolfe, MD, presented data and insight into his team’s utility of donation after cardiac death (DCD) heart transplant, on the heels of new advances in postmortem ischemic heart evaluation that allows clinicians to consider previously unwanted donations for waitlist patients.

The DCD heart transplant offering bucks the modern approach of lone donation after brain death practices, offered at most US transplant centers—in which donations occur following the cease of all brain function. MGH is among a few centers to offer DCD heart transplant, which occurs after a donor goes into circulatory arrest.

“As one might imagine, when you have a circulatory arrest, the heart is ischemic, so it’s historically been discouraged to use these donor organs,” Wolfe explained. “Although, every year there has been an increase in donation after circulatory deaths, so it’s something the heart transplant community has been very interested in pursuing.”

Wolfe spoke with HCPLive on the brief history of DCD heart transplant, which began after innovations to heart reanimation in 2019 allowed clinicians to evaluate DCD hearts for transplant benefit.

Now, centers like that at MGH are benefitting from a decreased waiting time for its heart transplant-eligible patients—as well as a new confidence in broadening its eligibly for transplantation.

“We’ve always wanted to push the envelope in improving patient care, and every year patients continue to die on the heart transplant waiting list,” Wolfe said. “When presented with opportunity to present a trial where we could expand the use of donation after circulatory deaths, our center hopped on that.”