Over the past three years, the median wait for a heart transplant at Duke has decreased by 57%, dropping from 170 days to just 73. The national median wait time for heart transplants declined by 35% during the same period to 167 days.
Published in the Scientific Registry of Transplant Recipients (SRTR), the data track median wait times for transplants performed from October 2018 to October 2021. The Duke Heart Transplant Program is among the nation’s leaders in offering short median wait times for patients eligible for heart transplant.
Duke’s participation in the donation after circulatory death (DCD) trial was a key reason for the improvement, says Adam DeVore, MD, MHS, medical director of the Duke Heart Transplant Program. One of five participating centers, the Duke team recorded the highest procedure volume in the DCD trial. Overall, in 2020, the DCD procedure represented approximately one-third of Duke transplants.
Other contributing initiatives included the acceptance of hearts from donors who were positive for Hepatitis B or Hepatitis C. The practice remains relatively new but increases organ availability.
DeVore also cites the program’s experienced cardiac anesthesia team, innovations in pre-transplant physical assessment and preparation for surgery, and a rigorous, multi-disciplinary team approach to patient case review and management.
The most important reason for the reduced wait time, DeVore says, is the team’s commitment to transplanting eligible patients as early as possible before advanced disease complicates post-transplant recovery.
“Because of our willingness to embrace these treatment innovations, we can offer transplants for patients who are not as far along in the disease course. This approach has many positives, particularly in long-term outcomes,” DeVore says.
A change in the national organ allocation system in 2018 prioritized hearts for the sickest patients by requiring that patients reach a more advanced disease stage before becoming eligible for transplant. Duke’s innovations have permitted the team to make more patients eligible earlier in the disease process.
“We prefer to offer transplants earlier, if possible, because we know these individuals are more likely to go home and thrive after transplant,” DeVore says. “We want them to do more than survive. We want them to do well and get back to living their lives as soon as possible.”
Improving resiliency before transplant
To improve outcomes, the Duke Heart Transplant team is piloting a new program to measure and improve components of physical resiliency before the procedure. The program has established measures for:
- standing and walking ability
- core strength
- mental health
- social well-being
Known as THRIVE-HF, the program develops metrics that indicate an individual’s readiness for transplant while offering a custom-tailored rehabilitation program to accelerate recovery.
“The idea is to prepare individuals for quicker recovery after surgery, with a detailed rehabilitation that helps strengthen specific proximal muscles to get them up and moving as quickly as possible,” DeVore says.
