Abstract 4143638: Donation After Circulatory Death in Pediatric Heart Transplant Recipients: A Lost Opportunity for Donor Pool Expansion

Background: Donation after circulatory death (DCD) is underutilized in pediatric heart transplant (HTx). Methods: UNOS database was analyzed for HTx with reported DCD donors (1/2020-4/2024). Data is reported as median (interquartile range). Multiorgan and retransplant recipients were excluded from outcome analysis. Results: The youngest DCD heart donor was <1 year old and the median age was 15 years. During the study period, 86 (4%) pediatric donors were DCD. However, in terms of pediatric recipients, DCD accounted for only 12 (0.9%) of the total pediatric HTx. The remaining pediatric DCD donors (74) were assigned to adult recipients. In the same period, all DCD donors accounted for 10% of adult HTx. The pediatric donor cohort was subdivided into 4 categories based on the recipient's age-group and whether the donor was DCD or not (table 1). Pediatric DCD hearts were allocated to lower priority listed recipients and those with blood group O (in both pediatric and adult recipients). Despite this, the total waitlist time was shorter among DCD recipients, suggesting the potential role of DCD to lower wait times. Distance travelled between donor to transplant center can be longer with DCD due to the use of a different organ care system. Table 1 summarizes the findings. Few UNOS regions (4, 5, 10, 11) are using pediatric DCD hearts for pediatric recipients (figure A). For outcome analysis, adult recipients who received pediatric DCD hearts were compared to those who received pediatric non-DCD hearts. No difference was noted in the one-year survival (figure B). Conclusion: Pediatric DCD heart for pediatric recipients represents an unexplored strategy for donor pool expansion.