The effect of warm ischemia and donor ejection fraction on 30-day mortality after donation after circulatory death heart transplantation: A national database analysis

Donation after circulatory death (DCD) donor hearts recovered using the direct procurement and perfusion method experience variable durations of warm ischemia at the time of procurement (WIP). We used the Organ Procurement and Transplantation Network database to assess the effect of WIP on 30-day mortality after DCD heart transplantation. The analysis evaluated outcomes in 237 recipients of DCD heart transplantation, demonstrating an optimal WIP cut point of < 36 minutes. Multivariable logistic regression modeling identified donor left ventricular ejection fraction (LVEF) < 60% as an independent predictor of 30-day mortality. The area under the receiver operating characteristic curve for predicting 30-day mortality based on WIP >= 36 minutes and donor LVEF < 60% was 0.90. Based on these findings, we do not recommend proceeding with DCD heart transplantation for patients with WIP >= 36 minutes, particularly in donors with LVEF < 60%.