Can We Safely Expand the DCD Donor Heart Pool by Extending the Donor Age Limit?

Background This study evaluates the impact of donor age on outcomes following donation after circulatory death (DCD) heart transplantation. Methods The UNOS registry was queried to analyze adult recipients who underwent isolated DCD heart transplantation from 1/1/2019 to 9/30/2023. The cohort was stratified into two groups according to donor age, where advanced donor age was defined as ≥40 years. Outcomes were 90-day and 1-year post-transplant survival. Propensity score-matching was performed. Sub-group analysis was performed to evaluate the effects of recipient age on 90-day survival among the recipients with advanced age donors. Results 994 recipients were included in the study period, and 161 patients (17.1%) received allografts from advanced age donors. During the study period, the annual incidence of DCD heart transplantation with advanced age donors substantially increased. The recipients with advanced age donors had similar 90-day and 1-year post-transplant survival compared to the recipients with younger donors. The comparable 90-day survival persisted in a propensity score-matched comparison. In the sub-group analysis among the recipients with advanced age donors, the recipients ≥60 years old had significantly reduced 90-day survival compared to the recipients <60 years old. Conclusions The use of appropriately selected DCD donors ≥40 years old has similar survival compared to that of younger donors. With careful candidate risk stratification and selection, consideration of using DCD donors over the age of 40 may further ameliorate ongoing organ shortage with comparable early post-transplant outcomes.