Logo image
Back
Should DCD Donor Hearts Be Used for ECMO-Bridged Recipients?
Abstract   Peer reviewed

Should DCD Donor Hearts Be Used for ECMO-Bridged Recipients?

J. Song, P. Cho, J. White, H. Zappacosta, S. McKay, A. Abramov, M. Daniel, M. Husain and A. Ardehali
The Journal of heart and lung transplantation, v 45(5), pp 306-306
Apr 2026
DOI: https://doi.org/10.1016/j.healun.2026.02.654

Abstract

Purpose: The use of donor hearts after circulatory death (DCD) for heart transplantation has expanded substantially in the United States. However, transplant centers remain cautious about offering DCD hearts to candidates supported with pre-transplant extracorporeal membrane oxygenation (ECMO). This study aims to assess the outcomes of DCD heart transplantation in patients bridged with ECMO. Methods: The United Network for Organ Sharing (UNOS) database was queried for adult recipients of isolated DCD heart transplants from 12/2019-6/2025. Patients were stratified between those with pre-transplant ECMO and those without ECMO (Control). Post-transplant outcomes included severe primary graft dysfunction (PGD, LV/BiV per ISHLT 2014 criteria), renal replacement therapy (RRT), hospital stay, 30-day mortality, and 6-month survival (Kaplan-Meier and Cox regression). Results: Among 2,460 DCD heart recipients, 4.2% (n=103) were on ECMO pre-transplant. Compared with non-ECMO recipients, ECMO patients were younger (median 50 vs 57 yr, p<0.001), more often on inotropes (52.4% vs 33.5%, p<0.001), and more frequently Status 1 (80.6% vs 2.9%, p<0.001). ECMO bridged recipients had higher severe PGD rates (15.9% vs 10.1%, p=0.07; data from 9/2023), were more likely to require RRT (35.9% vs 21.1%, p<0.001), and had longer hospital stay (median 27 vs 17 days, p<0.001). While 30-day mortality (5.8% vs 3.1%, p=0.14) and 6-month survival (91.1% vs 93.7%, p=0.31) were similar between the two groups, adjusted analysis showed that ECMO pre-transplant is an independent risk factor for 6-month mortality following DCD heart transplantation (adjusted hazard ratio: 2.18, 95% Confidence Interval: 1.10-4.33, p=0.025)(Figure 1). Conclusion: ECMO bridge status independently influences post-transplant mortality and is associated with higher perioperative risk among DCD heart recipients. These findings support the cautious use of DCD hearts in this population with appropriate risk awareness and perioperative management.

Metrics

1 Record Views

Details

Logo image