Whether center-level donor offer acceptance (DOA) aggressiveness — measured by the OPTN DOA ratio — was associated with early post-transplant outcomes in 5,393 adult heart transplants across 106 U.S. centers (January 2024–June 2025), with centers stratified into restrictive (Q1), intermediate (Q2–Q3), and aggressive (Q4) quartiles.
One-year recipient survival did not differ significantly across DOA groups in either Kaplan-Meier (p=0.253) or adjusted Cox proportional hazards analyses (p=0.277); rates of severe primary graft dysfunction requiring ECMO, post-transplant stroke, and hemodialysis were also comparable across groups.
The 18-month observation window limits longer-term outcome assessment; aggressive-DOA was moderately correlated with higher center volume, making it difficult to separate the effect of acceptance practices from center experience; unmeasured confounders inherent to retrospective, observational registry data may persist.
Transplant centers can pursue more aggressive donor heart acceptance — including older donors, DCD hearts, and greater travel distances — without worsening 1-year survival or major early complications, supporting broader organ utilization to expand access to heart transplantation.
