Outcomes of transplanted organs from donors with cardiac arrest by hanging in a nationwide Japanese cohort

The suitability of organs from cardiac arrest by hanging (CAH) donors remains controversial because of concerns regarding hypoxic organ injury. We conducted a nationwide retrospective cohort study using the Japan Organ Transplant Network database to evaluate transplant outcomes and organ yield among donors with a history of cardiac arrest between 2010 and 2023. Donors were categorized into CAH and cardiac arrest by non-hanging (CANH) groups. The primary outcome was graft survival by organ type, and the secondary outcome was the number of organs procured. A total of 415 donation after brain death donors (113 CAH, 302 CANH) and 161 donation after circulatory death donors (36 CAH, 125 CANH) were included. Among selected transplanted grafts, graft survival did not differ significantly between the CAH and CANH groups across organ types, and no significant associations were observed after adjustment for donor and recipient characteristics. Although the crude number of organs procured was higher in the CAH group, CAH donor status was not independently associated with organ yield. These findings support consideration of appropriately selected organs from CAH donors.