Waiting list mortality and the potential of donation after circulatory death heart transplantations in the Netherlands

• Published in: Netherlands heart journal Vol. 29; no. 2; pp. 88 - 97
• Main Authors: Roest, S., Kaffka genaamd Dengler, S. E., van Suylen, V., van der Kaaij, N. P., Damman, K., van Laake, L. W., Bekkers, J. A., Dalinghaus, M., Erasmus, M. E., Manintveld, O. C.
• Format: Journal Article
• Language: English
• Published: Houten Bohn Stafleu van Loghum 01-02-2021; Springer Nature B.V
• Subjects: Adults; Age; Blood groups; Brain death; Cardiology; Contraindications; Heart failure; Heart transplants; Ischemia; Medical Education; Medicine; Medicine & Public Health; Mortality; Original; Original Article; Patients; Pediatrics; Survival analysis; Transplants & implants; United States > US; Netherlands; Donation after circulatory death; Waiting list; Heart transplantation; Mortality
• ISSN: 1568-5888; 1876-6250
• DOI: 10.1007/s12471-020-01505-y

Background
With more patients qualifying for heart transplantation (HT) and fewer hearts being transplanted, it is vital to look for other options. To date, only organs from brain-dead donors have been used for HT in the Netherlands. We investigated waiting list mortality in all Dutch HT centres and the potential of donation after circulatory death (DCD) HT in the Netherlands.
Methods
Two different cohorts were evaluated. One cohort was defined as patients who were newly listed or were already on the waiting list for HT between January 2013 and December 2017. Follow-up continued until September 2018 and waiting list mortality was calculated. A second cohort of all DCD donors in the Netherlands (lung, liver, kidney and pancreas) between January 2013 and December 2017 was used to calculate the potential of DCD HT.
Results
Out of 395 patients on the waiting list for HT, 196 (50%) received transplants after a median waiting time of 2.6 years. In total, 15% died while on the waiting list before a suitable donor heart became available. We identified 1006 DCD donors. After applying exclusion criteria and an age limit of 50 years, 122 potential heart donors remained. This number increased to 220 when the age limit was extended to 57 years.
Conclusion
Waiting list mortality in the Netherlands is high. HT using organs from DCD donors has great potential in the Netherlands and could lead to a reduction in waiting list mortality. Cardiac screening will eventually determine the true potential.