Use of Cardiac Grafts from Suicidal Hanging Donors: Single-Center Experience

Purpose Donors of death due to anoxic brain injury such as suicidal hanging are at risk for a severe catecholamine surge leading to an acute myocardial stress that can cause global tissue hypoxia as well as pulmonary edema and barotrauma, all of which may potentially adversely impact myocardial tissue. Concerns have been raised about potential higher rates of Primary Graft Dysfunction (PGD) in heart transplant recipients of such donors due to this acute myocardial stressor. We wanted to assess if this mechanism of donor death does carry an increased risk of PGD or other adverse outcomes in our single center experience. Methods Between January 2014 and July 2019, 331 heart transplantations were performed at our center. Seventeen patients received a heart from donors after suicidal hanging, confirmed by review of the United Network for Organ Sharing UNet DonorNet database. Results Three out of 17 recipients (18%) from suicidal hanging donors experienced primary graft dysfunction (PGD) peri-operatively requiring extracorporeal membrane oxygenation (ECMO). In comparison, 29 out of 314 recipients (9%) from all other donors during this time period experienced PGD requiring peri-operative ECMO (p = 0.25). The 30-day and 1-year survival among recipients of grafts from suicidal hanging donors were 16/17 (94%) and 16/17 (94%), respectively. The one death during this period was due to complications from PGD (multi-system organ failure, ischemic limb with ECMO). Conclusion Overall, in a large-volume, single-center experience, while there was a trend toward a higher incidence of PGD requiring ECMO, transplantation of a heart from a suicidal hanging donor was not associated with a higher 30-day and 1-year mortality. Thus, these results suggest that hearts from suicidal hanging donors may be appropriately considered for transplantations, with heightened awareness of a possible increased risk of PGD requiring ECMO. Donors of death due to anoxic brain injury such as suicidal hanging are at risk for a severe catecholamine surge leading to an acute myocardial stress that can cause global tissue hypoxia as well as pulmonary edema and barotrauma, all of which may potentially adversely impact myocardial tissue. Concerns have been raised about potential higher rates of Primary Graft Dysfunction (PGD) in heart transplant recipients of such donors due to this acute myocardial stressor. We wanted to assess if this mechanism of donor death does carry an increased risk of PGD or other adverse outcomes in our single center experience. Between January 2014 and July 2019, 331 heart transplantations were performed at our center. Seventeen patients received a heart from donors after suicidal hanging, confirmed by review of the United Network for Organ Sharing UNet DonorNet database. Three out of 17 recipients (18%) from suicidal hanging donors experienced primary graft dysfunction (PGD) peri-operatively requiring extracorporeal membrane oxygenation (ECMO). In comparison, 29 out of 314 recipients (9%) from all other donors during this time period experienced PGD requiring peri-operative ECMO (p = 0.25). The 30-day and 1-year survival among recipients of grafts from suicidal hanging donors were 16/17 (94%) and 16/17 (94%), respectively. The one death during this period was due to complications from PGD (multi-system organ failure, ischemic limb with ECMO). Overall, in a large-volume, single-center experience, while there was a trend toward a higher incidence of PGD requiring ECMO, transplantation of a heart from a suicidal hanging donor was not associated with a higher 30-day and 1-year mortality. Thus, these results suggest that hearts from suicidal hanging donors may be appropriately considered for transplantations, with heightened awareness of a possible increased risk of PGD requiring ECMO.