A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom

Simon Messer; Sally Rushton; Lewis Simmonds; Debbie Macklam; Mubbasher Husain; Anand Jothidasan; Stephen Large; Steven Tsui; Pradeep Kaul; Jennifer Baxter; Mohamed Osman; Vipin Mehta; Derval Russell; Uli Stock; John Dunning; Diana Garcia Saez; Rajamiyer Venkateswaran; Philip Curry; Lynne Ayton; Majid Mukadam; Jorge Mascaro; Jacob Simmonds; Guy Macgowan; Stephen Clark; Jerome Jungschleger; Zdenka Reinhardt; Richard Quigley; Jane Speed; Jayan Parameshwar; David Jenkins; Sarah Watson; Fiona Marley; Ayesha Ali; Dale Gardiner; Antonio Rubino; Julie Whitney; Sarah Beale; Catherine Slater; Ian Currie; Liz Armstrong; Jeanette Foley; Marian Ryan; Sharon Gibson; Karen Quinn; Anna Maria Macleod; Susan Spence; Christopher J.E. Watson; Pedro Catarino; Anthony Clarkson; John Forsythe; Derek Manas; Marius Berman

doi:10.1016/j.healun.2023.03.006

A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom

Simon Messer, Sally Rushton, Lewis Simmonds, Debbie Macklam, Mubbasher Husain, Anand Jothidasan, Stephen Large, Steven Tsui, Pradeep Kaul, Jennifer Baxter, Mohamed Osman, Vipin Mehta, Derval Russell, Uli Stock, John Dunning, Diana Garcia Saez, Rajamiyer Venkateswaran, Philip Curry, Lynne Ayton, Majid MukadamJorge Mascaro, Jacob Simmonds, Guy Macgowan, Stephen Clark, Jerome Jungschleger, Zdenka Reinhardt, Richard Quigley, Jane Speed, Jayan Parameshwar, David Jenkins, Sarah Watson, Fiona Marley, Ayesha Ali, Dale Gardiner, Antonio Rubino, Julie Whitney, Sarah Beale, Catherine Slater, Ian Currie, Liz Armstrong, Jeanette Foley, Marian Ryan, Sharon Gibson, Karen Quinn, Anna Maria Macleod, Susan Spence, Christopher J.E. Watson, Pedro Catarino, Anthony Clarkson, John Forsythe, Derek Manas, Marius Berman^*

^*Corresponding author for this work

Applied Sciences Department

Research output: Contribution to journal › Article › peer-review

13 Citations (Scopus)

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Abstract

Background: The United Kingdom (UK) was one of the first countries to pioneer heart transplantation from donation after circulatory death (DCD) donors. To facilitate equity of access to DCD hearts by all UK heart transplant centers and expand the retrieval zone nationwide, a Joint Innovation Fund (JIF) pilot was provided by NHS Blood and Transplant (NHSBT) and NHS England (NHSE). The activity and outcomes of this national DCD heart pilot program are reported. Methods: This is a national multi-center, retrospective cohort study examining early outcomes of DCD heart transplants performed across 7 heart transplant centers, adult and pediatric, throughout the UK. Hearts were retrieved using the direct procurement and perfusion (DPP) technique by 3 specialist retrieval teams trained in ex-situ normothermic machine perfusion. Outcomes were compared against DCD heart transplants before the national pilot era and against contemporaneous donation after brain death (DBD) heart transplants, and analyzed using Kaplan-Meier analysis, chi-square test, and Wilcoxon's rank-sum. Results: From September 7, 2020 to February 28, 2022, 215 potential DCD hearts were offered of which 98 (46%) were accepted and attended. There were 77 potential donors (36%) which proceeded to death within 2 hours, with 57 (27%) donor hearts successfully retrieved and perfused ex situ and 50 (23%) DCD hearts going on to be transplanted. During this same period, 179 DBD hearts were transplanted. Overall, there was no difference in the 30-day survival rate between DCD and DBD (94% vs 93%) or 90 day survival (90% vs 90%) respectively. There was a higher rate of ECMO use post-DCD heart transplants compared to DBD (40% vs 16%, p = 0.0006), and DCD hearts in the pre pilot era, (17%, p = 0.002). There was no difference in length of ICU stay (9 DCD vs 8 days DBD, p = 0.13) nor hospital stay (28 DCD vs 27 DBD days, p = 0.46). Conclusion: During this pilot study, 3 specialist retrieval teams were able to retrieve DCD hearts nationally for all 7 UK heart transplant centers. DCD donors increased overall heart transplantation in the UK by 28% with equivalent early posttransplant survival compared with DBD donors.

Original language	English
Pages (from-to)	1120-1130
Number of pages	11
Journal	Journal of Heart and Lung Transplantation
Volume	42
Issue number	8
Early online date	13 Mar 2023
DOIs	https://doi.org/10.1016/j.healun.2023.03.006
Publication status	Published - 1 Aug 2023

Keywords

circulatory death
circulatory determined death
ex-situ heart perfusion system
heart
transplant

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Messer, S., Rushton, S., Simmonds, L., Macklam, D., Husain, M., Jothidasan, A., Large, S., Tsui, S., Kaul, P., Baxter, J., Osman, M., Mehta, V., Russell, D., Stock, U., Dunning, J., Saez, D. G., Venkateswaran, R., Curry, P., Ayton, L., ... Berman, M. (2023). A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom. Journal of Heart and Lung Transplantation, 42(8), 1120-1130. https://doi.org/10.1016/j.healun.2023.03.006

@article{50b2fd0f455d498da961dc857ae2a1e0,

title = "A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom",

abstract = "Background: The United Kingdom (UK) was one of the first countries to pioneer heart transplantation from donation after circulatory death (DCD) donors. To facilitate equity of access to DCD hearts by all UK heart transplant centers and expand the retrieval zone nationwide, a Joint Innovation Fund (JIF) pilot was provided by NHS Blood and Transplant (NHSBT) and NHS England (NHSE). The activity and outcomes of this national DCD heart pilot program are reported. Methods: This is a national multi-center, retrospective cohort study examining early outcomes of DCD heart transplants performed across 7 heart transplant centers, adult and pediatric, throughout the UK. Hearts were retrieved using the direct procurement and perfusion (DPP) technique by 3 specialist retrieval teams trained in ex-situ normothermic machine perfusion. Outcomes were compared against DCD heart transplants before the national pilot era and against contemporaneous donation after brain death (DBD) heart transplants, and analyzed using Kaplan-Meier analysis, chi-square test, and Wilcoxon's rank-sum. Results: From September 7, 2020 to February 28, 2022, 215 potential DCD hearts were offered of which 98 (46%) were accepted and attended. There were 77 potential donors (36%) which proceeded to death within 2 hours, with 57 (27%) donor hearts successfully retrieved and perfused ex situ and 50 (23%) DCD hearts going on to be transplanted. During this same period, 179 DBD hearts were transplanted. Overall, there was no difference in the 30-day survival rate between DCD and DBD (94% vs 93%) or 90 day survival (90% vs 90%) respectively. There was a higher rate of ECMO use post-DCD heart transplants compared to DBD (40% vs 16%, p = 0.0006), and DCD hearts in the pre pilot era, (17%, p = 0.002). There was no difference in length of ICU stay (9 DCD vs 8 days DBD, p = 0.13) nor hospital stay (28 DCD vs 27 DBD days, p = 0.46). Conclusion: During this pilot study, 3 specialist retrieval teams were able to retrieve DCD hearts nationally for all 7 UK heart transplant centers. DCD donors increased overall heart transplantation in the UK by 28% with equivalent early posttransplant survival compared with DBD donors.",

keywords = "circulatory death, circulatory determined death, ex-situ heart perfusion system, heart, transplant",

author = "Simon Messer and Sally Rushton and Lewis Simmonds and Debbie Macklam and Mubbasher Husain and Anand Jothidasan and Stephen Large and Steven Tsui and Pradeep Kaul and Jennifer Baxter and Mohamed Osman and Vipin Mehta and Derval Russell and Uli Stock and John Dunning and Saez, {Diana Garcia} and Rajamiyer Venkateswaran and Philip Curry and Lynne Ayton and Majid Mukadam and Jorge Mascaro and Jacob Simmonds and Guy Macgowan and Stephen Clark and Jerome Jungschleger and Zdenka Reinhardt and Richard Quigley and Jane Speed and Jayan Parameshwar and David Jenkins and Sarah Watson and Fiona Marley and Ayesha Ali and Dale Gardiner and Antonio Rubino and Julie Whitney and Sarah Beale and Catherine Slater and Ian Currie and Liz Armstrong and Jeanette Foley and Marian Ryan and Sharon Gibson and Karen Quinn and Macleod, {Anna Maria} and Susan Spence and Watson, {Christopher J.E.} and Pedro Catarino and Anthony Clarkson and John Forsythe and Derek Manas and Marius Berman",

note = "Funding Information: To address these needs, a national joint innovation fund (JIF) pilot study was funded by National Health Service Blood and Transplant (NHSBT) and National Health Service England (NHSE). The activity and outcomes of this national pilot program, between September 7, 2020 and February 28, 2022, are reported.",

year = "2023",

month = aug,

day = "1",

doi = "10.1016/j.healun.2023.03.006",

language = "English",

volume = "42",

pages = "1120--1130",

journal = "Journal of Heart and Lung Transplantation",

issn = "1053-2498",

publisher = "Elsevier",

number = "8",

}

Messer, S, Rushton, S, Simmonds, L, Macklam, D, Husain, M, Jothidasan, A, Large, S, Tsui, S, Kaul, P, Baxter, J, Osman, M, Mehta, V, Russell, D, Stock, U, Dunning, J, Saez, DG, Venkateswaran, R, Curry, P, Ayton, L, Mukadam, M, Mascaro, J, Simmonds, J, Macgowan, G, Clark, S, Jungschleger, J, Reinhardt, Z, Quigley, R, Speed, J, Parameshwar, J, Jenkins, D, Watson, S, Marley, F, Ali, A, Gardiner, D, Rubino, A, Whitney, J, Beale, S, Slater, C, Currie, I, Armstrong, L, Foley, J, Ryan, M, Gibson, S, Quinn, K, Macleod, AM, Spence, S, Watson, CJE, Catarino, P, Clarkson, A, Forsythe, J, Manas, D & Berman, M 2023, 'A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom', Journal of Heart and Lung Transplantation, vol. 42, no. 8, pp. 1120-1130. https://doi.org/10.1016/j.healun.2023.03.006

TY - JOUR

T1 - A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom

AU - Messer, Simon

AU - Rushton, Sally

AU - Simmonds, Lewis

AU - Macklam, Debbie

AU - Husain, Mubbasher

AU - Jothidasan, Anand

AU - Large, Stephen

AU - Tsui, Steven

AU - Kaul, Pradeep

AU - Baxter, Jennifer

AU - Osman, Mohamed

AU - Mehta, Vipin

AU - Russell, Derval

AU - Stock, Uli

AU - Dunning, John

AU - Saez, Diana Garcia

AU - Venkateswaran, Rajamiyer

AU - Curry, Philip

AU - Ayton, Lynne

AU - Mukadam, Majid

AU - Mascaro, Jorge

AU - Simmonds, Jacob

AU - Macgowan, Guy

AU - Clark, Stephen

AU - Jungschleger, Jerome

AU - Reinhardt, Zdenka

AU - Quigley, Richard

AU - Speed, Jane

AU - Parameshwar, Jayan

AU - Jenkins, David

AU - Watson, Sarah

AU - Marley, Fiona

AU - Ali, Ayesha

AU - Gardiner, Dale

AU - Rubino, Antonio

AU - Whitney, Julie

AU - Beale, Sarah

AU - Slater, Catherine

AU - Currie, Ian

AU - Armstrong, Liz

AU - Foley, Jeanette

AU - Ryan, Marian

AU - Gibson, Sharon

AU - Quinn, Karen

AU - Macleod, Anna Maria

AU - Spence, Susan

AU - Watson, Christopher J.E.

AU - Catarino, Pedro

AU - Clarkson, Anthony

AU - Forsythe, John

AU - Manas, Derek

AU - Berman, Marius

N1 - Funding Information: To address these needs, a national joint innovation fund (JIF) pilot study was funded by National Health Service Blood and Transplant (NHSBT) and National Health Service England (NHSE). The activity and outcomes of this national pilot program, between September 7, 2020 and February 28, 2022, are reported.

PY - 2023/8/1

Y1 - 2023/8/1

N2 - Background: The United Kingdom (UK) was one of the first countries to pioneer heart transplantation from donation after circulatory death (DCD) donors. To facilitate equity of access to DCD hearts by all UK heart transplant centers and expand the retrieval zone nationwide, a Joint Innovation Fund (JIF) pilot was provided by NHS Blood and Transplant (NHSBT) and NHS England (NHSE). The activity and outcomes of this national DCD heart pilot program are reported. Methods: This is a national multi-center, retrospective cohort study examining early outcomes of DCD heart transplants performed across 7 heart transplant centers, adult and pediatric, throughout the UK. Hearts were retrieved using the direct procurement and perfusion (DPP) technique by 3 specialist retrieval teams trained in ex-situ normothermic machine perfusion. Outcomes were compared against DCD heart transplants before the national pilot era and against contemporaneous donation after brain death (DBD) heart transplants, and analyzed using Kaplan-Meier analysis, chi-square test, and Wilcoxon's rank-sum. Results: From September 7, 2020 to February 28, 2022, 215 potential DCD hearts were offered of which 98 (46%) were accepted and attended. There were 77 potential donors (36%) which proceeded to death within 2 hours, with 57 (27%) donor hearts successfully retrieved and perfused ex situ and 50 (23%) DCD hearts going on to be transplanted. During this same period, 179 DBD hearts were transplanted. Overall, there was no difference in the 30-day survival rate between DCD and DBD (94% vs 93%) or 90 day survival (90% vs 90%) respectively. There was a higher rate of ECMO use post-DCD heart transplants compared to DBD (40% vs 16%, p = 0.0006), and DCD hearts in the pre pilot era, (17%, p = 0.002). There was no difference in length of ICU stay (9 DCD vs 8 days DBD, p = 0.13) nor hospital stay (28 DCD vs 27 DBD days, p = 0.46). Conclusion: During this pilot study, 3 specialist retrieval teams were able to retrieve DCD hearts nationally for all 7 UK heart transplant centers. DCD donors increased overall heart transplantation in the UK by 28% with equivalent early posttransplant survival compared with DBD donors.

AB - Background: The United Kingdom (UK) was one of the first countries to pioneer heart transplantation from donation after circulatory death (DCD) donors. To facilitate equity of access to DCD hearts by all UK heart transplant centers and expand the retrieval zone nationwide, a Joint Innovation Fund (JIF) pilot was provided by NHS Blood and Transplant (NHSBT) and NHS England (NHSE). The activity and outcomes of this national DCD heart pilot program are reported. Methods: This is a national multi-center, retrospective cohort study examining early outcomes of DCD heart transplants performed across 7 heart transplant centers, adult and pediatric, throughout the UK. Hearts were retrieved using the direct procurement and perfusion (DPP) technique by 3 specialist retrieval teams trained in ex-situ normothermic machine perfusion. Outcomes were compared against DCD heart transplants before the national pilot era and against contemporaneous donation after brain death (DBD) heart transplants, and analyzed using Kaplan-Meier analysis, chi-square test, and Wilcoxon's rank-sum. Results: From September 7, 2020 to February 28, 2022, 215 potential DCD hearts were offered of which 98 (46%) were accepted and attended. There were 77 potential donors (36%) which proceeded to death within 2 hours, with 57 (27%) donor hearts successfully retrieved and perfused ex situ and 50 (23%) DCD hearts going on to be transplanted. During this same period, 179 DBD hearts were transplanted. Overall, there was no difference in the 30-day survival rate between DCD and DBD (94% vs 93%) or 90 day survival (90% vs 90%) respectively. There was a higher rate of ECMO use post-DCD heart transplants compared to DBD (40% vs 16%, p = 0.0006), and DCD hearts in the pre pilot era, (17%, p = 0.002). There was no difference in length of ICU stay (9 DCD vs 8 days DBD, p = 0.13) nor hospital stay (28 DCD vs 27 DBD days, p = 0.46). Conclusion: During this pilot study, 3 specialist retrieval teams were able to retrieve DCD hearts nationally for all 7 UK heart transplant centers. DCD donors increased overall heart transplantation in the UK by 28% with equivalent early posttransplant survival compared with DBD donors.

KW - circulatory death

KW - circulatory determined death

KW - ex-situ heart perfusion system

KW - heart

KW - transplant

UR - http://www.scopus.com/inward/record.url?scp=85152665474&partnerID=8YFLogxK

U2 - 10.1016/j.healun.2023.03.006

DO - 10.1016/j.healun.2023.03.006

M3 - Article

C2 - 37032222

AN - SCOPUS:85152665474

SN - 1053-2498

VL - 42

SP - 1120

EP - 1130

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

IS - 8

ER -

A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom

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