Impact of donor mechanism of injury on donation after circulatory death heart transplant outcomes: An analysis of the UNOS National Registry.

Previous research associates explosive brain death (EBD) with inferior recipient outcomes in donation after brain death (DBD) heart transplantation. Current international guidelines recommend caution when using these organs. We investigated whether donor mechanism of injury impacts outcomes in donation after circulatory death (DCD) heart transplantation. First-time heart transplant recipients were stratified by donor mechanism of injury. No significant difference in 4-year recipient survival was detected across donor mechanism of injury categories on univariate analysis (log-rank p = 0.65). Compared with head trauma, there was no significant difference in adjusted hazard ratios among recipients of donors who experienced anoxia (aHR 0.91, 95% CI 0.65-1.28), CVA/stroke (aHR 1.32, 95% CI 0.78-2.24), or other causes (aHR 1.23, 95% CI 0.80-1.90). Severe primary graft dysfunction (PGD) was less likely in recipients of donors who experienced anoxia compared to head trauma (aOR 0.36, 95% CI 0.16-0.78, p = 0.009).