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Impact of Prior Drug Use on Rebound Effect During DCD Donation
Abstract   Peer reviewed

Impact of Prior Drug Use on Rebound Effect During DCD Donation

J. White, P. Cho, H. Zappacosta, S. McKay, J. Song, A. Abramov, M. Daniel, D. Telesca, M. Husain and A. Ardehali
The Journal of heart and lung transplantation, v 45(5), pp 174-175
Apr 2026
DOI: https://doi.org/10.1016/j.healun.2026.02.371

Abstract

Purpose: Donation after Circulatory Death (DCD) donations have become a large share of the donor organ pool in the United States. Some have observed that after extubation donors may experience a rapid deterioration in vital signs followed by a rebound effect. One possible explanation is that donors with prior drug use may have pre-conditioned ischemia leading to prolonged expiration, reduced yield of viable organs and decreased organ quality. Therefore, this study seeks to analyze the relationship between prior drug use and the occurrence of rebound effect. Methods: Patients from a single organ procurement organization (OPO) from January 2014 to June 2025 were analyzed for post-extubation vital signs at regular intervals. Rebound was defined as a >20 point systolic blood pressure (SBP) increase following a drop below 80 or 50 mmHg. The effect was measured at two different SBPs due to varied OPO protocols. Patients were matched to UNOS data for prior drug use variables with differing sample sizes due to length of collection time. Multivariate analysis was performed with p-values calculated as two-sided tests with p<.05 indicating significance, reported as (Odds Ratio, 95% CI, p-value). Results: A total of 1,006 DCD donors were identified during the study period, of which 122 and 101 experienced a >20mmHg rebound effect after dipping below 80 and 50mmHg, respectively. Univariate and multivariate analysis (Table 1) revealed no statistically significant associations between any drug use and the occurrence of rebound effect. In multivariate analysis, amphetamine use was the closest variable to significance but had a reduced incidence of rebound effect at the SBP 80 threshold (0.24, 0.06-1.00, 0.05). Conclusion: The presence of rebound effect is not correlated with prior drug use. Our study is limited by small sample size, especially amongst the newer, more specific drug use variables. Additionally, the study omitted individuals who did not progress to donation, amongst whom rebound effect could theoretically be the most prominent.

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