Fate of Discarded Hearts Donated After Circulatory Death: Is There an Opportunity for Novel Use?

Background: Use of hearts identified as eligible for donation after circulatory death (DCD) has been largely suboptimal. We aimed to study how hearts identified as eligible for DCD in the United States have been used and discuss whether innovative techniques or alternate use can enhance allocation of these hearts to benefit children and adults with heart disease. Methods: Data from United Network for Organ Sharing database of all eligible DCD donors from January 2013 to December 2022 were analyzed. Donor data were categorized based on heart disposition as not recovered, recovered not for transplant, and recovered for transplant but not transplanted. Results: Overall, 5244 hearts considered eligible for DCD were not transplanted, accounting for 421 hearts per year between 2013 and 2017 and 523 hearts per year between 2018 and 2022. Of these, 3786 hearts (72.2%; 976 from eligible donors aged <18 years) were never recovered, 1425 hearts (27.2%; 608 from pediatric donors) were recovered but not for transplant, and 33 hearts (0.6%; 5 from pediatric donors) were recovered for transplant but not transplanted. Among donors whose organs were not used for transplant, 98% were nondiabetic, 96% were normotensive, and 99.5% were free of coronary artery disease. Conclusions: A large percentage of hearts identified as eligible for DCD are currently not used. These hearts represent a potential source for expanding the pool of donor hearts for transplantation and for novel techniques, such as a partial heart transplant, particularly in the pediatric population.