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Abstract   Aim  The quality of the donor heart is known to have a crucial effect on outcome after heart transplantation (HTx). Although leading to brain death in the end, the initial cause of death of the donor and its potential influences on organ quality are heterogeneous. However, it is still controversial to which extent the donor cause of death is associated with outcome or survival post‐HTx.    Methods and results  We included all patients undergoing HTx in our centre between September 2010 and June 2021 ( n  = 218). Recipients were divided in five groups related to their donor cause of death: intracerebral bleeding (‘ICB’,  n  = 95, 44%), traumatic brain injury (‘trauma’,  n  = 54, 25%), hypoxic brain damage (‘hypoxic’,  n  = 34, 16%), cerebrovascular (‘vascular’,  n  = 15, 7%), or other cause ( n  = 20, 9%). Baseline characteristics, perioperative parameters, and survival after 30 and 90 days as well as 5 years after transplantation were collected.    Results  Intracerebral bleeding in donors compared with traumatic brain injury is associated with higher probability of need for ECLS post‐HTx (35% vs. 19%,  P  = 0.04) and significantly reduced survival up to 5 years post‐HTx (i.e. 1 year survival: 61% vs. 95%,  P  &lt; 0.0001). Although other conditions also show significant changes in outcome and survival, the effect is strongest for ICB, where survival is also reduced compared with all other causes (1 year: 61% vs. 89%,  P  &lt; 0.0001).    Conclusions  In this retrospective analysis, donor cause of death is associated with differing outcome and survival after HTx. Intracerebral bleeding hereby shows strongest decline in outcome and survival in comparison with all other causes.

Intracerebral bleeding in donors is associated with reduced short‐term to midterm survival of heart transplant recipients