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Updated: Aug 18, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Donor heart selection: Wythenshawe experience
N Khasati1, J Barnard, M N Bittar
1From the Transplant Centre, South Manchester University Hospitals NHS Trust, Manchester, England.
Insights
Donor hearts medically unsuitable for transplantation at one center showed significantly higher recipient mortality. Caution is advised when using these grafts, especially with multiple adverse factors, to improve heart transplant outcomes.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Organ Donation
Background:
- Declining availability of suitable donor hearts necessitates exploring utilization of previously unacceptable donors.
- Investigating outcomes of donor hearts deemed medically unsuitable by one center but transplanted elsewhere.
Purpose of the Study:
- To evaluate the clinical outcomes of heart transplant recipients receiving grafts from donors initially declined for medical reasons.
Main Methods:
- Retrospective analysis of 40 medically unsuitable donor hearts (Group 1) versus 104 suitable donor hearts (Group 2) transplanted between April 1998 and March 2003.
- Data sourced from the United Kingdom Cardiothoracic Transplant Audit database.
- Mortality analysis performed using SPSS software.
Main Results:
- Significantly higher mortality observed in recipients of Group 1 donor hearts compared to Group 2 (P < .0009).
- Graft failure accounted for 50% of early deaths in the medically unsuitable donor group.
- High-dose inotrope use, prolonged ischemic time (>3.5 hours), and high-risk recipients were associated with poor outcomes in Group 1.
Conclusions:
- Donor hearts declined on medical grounds require careful evaluation before transplantation.
- The presence of multiple adverse factors in a donor heart significantly increases transplant risk.
Background:
The decline in the number of suitable donor hearts has led to an increasing interest in the use of previously unacceptable donors. This study aimed to evaluate the outcome of recipients of donor hearts considered medically unsuitable for transplantation at this center that were used in other centers in the United Kingdom.
Methods:
Forty donor hearts (group 1) were declined by Wythenshawe Hospital and used in other units in the United Kingdom in the period extending from April 1998 to March 2003. One hundred four hearts (group 2) were transplanted at Wythenshawe Hospital during the same period. Donors and recipient data were obtained from the United Kingdom Cardiothoracic Transplant Audit database. Mortality in both groups was analyzed using SPSS software.
Results:
Mortality in patients receiving grafts from group 1 donors was significantly higher than in group 2 (P < .0009). Of the early deaths in this group 50% (6 of 12) were the result of graft failure. These donors were receiving high doses of inotropes, had ischemic time exceeding 3.5 hours, and the grafts were transplanted into high-risk patients.
Conclusion:
Hearts declined on medical grounds by one center should be evaluated with caution before being considered suitable for transplantation, especially when more than one adverse factor is present.
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