DURHAM – For decades, doctors have used hearts donated after brain death as the standard of care.
A relatively new method of heart transplantation, which allows for the use of hearts donated after circulatory death (DCD), could expand the pool of available donor hearts by a projected 30%.
Traditionally, hearts could not be donated after cardiac death. The DCD method in the study uses a machine to keep the heart pumping, making it viable for donation, but also enabling the organ to travel further.
A study led by Duke Health physicians, appearing online June 8 in the New England Journal of Medicine, found that DCD hearts were equivalent to hearts procured through the current standard of care.
“This should eliminate any barriers for transplant centers to offer this to their patients because we now have objective, randomized data showing both types of hearts are equivalent,” said Jacob Schroder, M.D., corresponding author and assistant professor in the Department of Surgery at the Duke University School of Medicine.
The study enrolled 180 patients, with half receiving DCD hearts and the other half receiving brain death hearts. It compared risk-adjusted survival at six months and found a survival rate of 94% for those who received a DCD heart and 90% for those who received hearts donated after brain death.
Researchers also looked at serious adverse events 30 days after transplantation, with the mean number of such events at 0.2 for DCD and 0.1 for the standard donated hearts.
Duke Health helped pioneer the use of DCD in the United States, performing the country’s first DCD heart transplant and pediatric DCD heart transplant. The company that developed the technology to keep a DCD heart pumping during transit, TransMedics, sponsored this study.
Duke is now one of around twenty transplant centers in the country that provide DCD heart transplants. Researchers believe the validation from this study should galvanize other centers to consider adopting the method.
“We’ve remained committed to studying the viability of this method out of an aggressive desire to take care of and provide life-saving options for our patients,” said Chetan Patel, M.D., study author and associate professor in the Department of Medicine.
“Our goal has always been to expand the donor pool to offer heart transplantation to as many patients in need as possible, said Adam DeVore, M.D., study author and associate professor in the Department of Medicine.
“By finishing and publishing the DCD Heart study, we offer a clear roadmap for other centers to adopt this practice as well,” DeVore said.
In addition to Schroder, Patel and DeVore, study authors include Benjamin S. Bryner, Sarah Casalinova, Ashish Shah, Jason W. Smith, Amy G. Fiedler, Mani Daneshmand, Scott Silvestry, Arnar Geirsson, Victor Pretorius, David L. Joyce, John Y. Um, Fardad Esmailian, Koji Takeda, Karol Mudy, Yasuhiro Shudo, Christopher T. Salerno, Si M. Pham, Daniel J. Goldstein, Jonathan Philpott, John Dunning, Lucian Lozonschi, Gregory S. Couper, Hari Reddy Mallidi, Michael M. Givertz, Duc Thinh Pham, Andrew W. Shaffer, Masashi Kai, Mohammed A. Quader, Tarek Absi, Tamer S. Attia, Bassam Shukrallah, Ben C. Sun, Maryjane Farr, Mandeep R. Mehra, Joren C. Madsen, Carmelo A. Milano, and David A. D’Alessandro.
(C) Duke University