Heart Transplantation Utilizing Brain-Dead Donors Procured From Extended Distances Under the 2018 New Allocation Policy.

Purpose: There are limited data regarding outcomes of a new heart allocation policy on recovering brain-death donors (DBD) from extended distances.

Methods: From May 6, 2014, to March 31, 2023, the United Network for Organ Sharing database was queried where 1885 cases (8.3%) out of 22 806 isolated heart transplants received donor hearts from extended distances (ED) greater than 500 miles. Patients were divided into groups based on the transplanted date before or after the policy change (October 18, 2018): old (N = 443) versus new (N = 1383). A total of 439 pairs were matched utilizing propensity score matching.

Results: The utilization of hearts from ED in the new system increased 2.7 times. Before matching, characteristics that differed included new group recipients with higher usage of temporary mechanical circulatory support devices and donors with more anoxia as the cause of death (new, 47% vs. old, 37%; p < 0.001). In the matched cohort, the incidences of dialysis (14% vs. 11%, p = 0.18), stroke (3.9% vs. 2.7%, p = 0.44), or pacemaker implantation (3.0% vs. 2.5%, p = 0.83) were similar. Both groups showed similar 1-year recipient survival (90.9% vs. 90.4%, p = 0.79) and graft survival (90.7% vs. 90.2%, p = 0.8).

Conclusion: In the new allocation policy, the utilization of hearts from ED has increased approximately three-fold compared to the period before the policy change without affecting transplant outcomes.