Donation after circulatory death transplantation: a systematic review and meta-analysis of outcomes and methods of donation.
Jolliffe, J., et al.Annals of Cardiothoracic Surgery 2025; 14(1): 11-27.
Aims
This study aims to synthesise the available evidence comparing outcomes of donation after circulatory death (DCD) versus donation after brain death (DBD) following heart transplantation.
Interventions
A literature search was performed using the following databases: Medline, EMBASE and Cochrane, CINAHL,Trove, Proquest, and Clinical Trials databases. The methodological quality of the included studies was assessed using the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool for non-randomised studies and Risk of Bias 2 (ROB-2) tool for randomised studies. Data were extracted by two independent reviewers.
Participants
10 studies were included in the review.
Outcomes
The primary outcomes were survival, acute rejection and primary graft dysfunction (PGD). The secondary outcomes were temporary dialysis, length of stay (LOS) and intensive care unit (ICU) LOS.
Follow-up
N/A
CET Conclusions
This systematic review aimed to evaluate two different methods of donation: donation after brain death (DBD) versus donation after circulatory death (DCD). Multiple databases were searched for relevant literature. Quality assessment and data extraction were performed by two independent reviewers. A total of 10 studies were included—all were retrospective cohort studies apart from one randomised controlled trial. The authors concluded that DCD may offer similar outcomes to DBD. There are a few issues with the methodology and the reporting of this paper. It is not clear whether it was the ‘literature search’ or the ‘study screening and selection’ that was performed in duplicate. Some of the studies included in this review do not compare DCD with DBD (i.e. no comparator group). The authors have used both the fixed effect and the random-effect models in their meta-analysis, which creates a bit of confusion to the readers when interpreting the results. Given that the studies included in the review were primarily retrospective cohort studies, the authors should have used the random-effects model. Heterogeneity was significant for some of the key outcomes, which the authors do not attempt to explore using any statistical tests. The effect of confounders in the analysis have not been accounted for. The authors also reported a significant difference between DBD and DCD with regard to 6-month survival in the abstract, but details of this analysis cannot be found anywhere else in the paper.
Trial registration
N/A