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Updated: Aug 13, 2026
Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography
Published on: October 11, 2022
Recruitment of aged donor heart with pharmacological stress echo. A case report
Giorgio Arpesella1, Sonia Gherardi, Tonino Bombardini
1Department of Surgery and Transplants, Univeresity of Bologna, Italy. arpesella@aosp.bo.it
Insights
Stress echocardiography effectively screens potential donor hearts for disease, increasing organ availability. This feasible, cost-effective method helps address the critical shortage of donor hearts for transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Diagnostic Imaging
Background:
- Heart transplantation is a life-saving treatment for end-stage heart failure.
- Donor organ shortage limits the number of heart transplantations performed.
- Current screening methods for donor hearts, like coronary angiography, exclude many potentially viable organs.
Observation:
- A marginal donor heart from a 57-year-old woman was evaluated using transesophageal Dipyridamole stress echocardiography.
- The stress echo revealed normal wall motion and no signs of inducible ischemia, indicating no significant heart or coronary artery disease.
- The donor heart was successfully transplanted into a 63-year-old recipient with severe heart failure.
Findings:
- Stress echocardiography successfully identified the donor heart as suitable for transplantation.
- Post-transplant echocardiography and coronary angiography confirmed normal function and absence of disease in the transplanted heart.
- The donor heart exhibited normal dimensions and ventricular function one week after transplantation.
Implications:
- Stress echocardiography offers a feasible, cost-effective, and sustainable alternative for screening donor hearts.
- This method can help overcome the donor heart shortage by enabling the use of more 'marginal' donor organs.
- Utilizing stress echo for donor heart selection can increase the supply of viable organs for transplantation.
Background:
The heart transplant is a treatment of the heart failure, which is not responding to medications, and its efficiency is already proved: unfortunately, organ donation is a limiting step of this life-saving procedure. To counteract heart donor shortage, we should screen aged potential donor hearts for initial cardiomyopathy and functionally significant coronary artery disease. Donors with a history of cardiac disease are generally excluded. Coronary angiography is recommended for most male donors older than 45 years and female donors older than 50 years to evaluate coronary artery stenoses. A simpler way to screen aged potential donor hearts for initial cardiomyopathy and functionally significant coronary artery disease should be stress echocardiography.
Case Report:
A marginal donor (A 57 year old woman meeting legal requirements for brain death) underwent a transesophageal (TE) Dipyridamole stress echo (6 minutes accelerated protocol) to rule out moderate or severe heart and coronary artery disease. Wall motion was normal at baseline and at peak stress (WMSI = 1 at baseline and peak stress, without signs of stress inducible ischemia). The pressure/volume ratio was 9.6 mmHg/ml/m2 at baseline, increasing to 14 mmHg/ml/m2 at peak stress, demonstrating absence of latent myocardial dysfunction. The marginal donor heart was transplanted to a recipient "marginal" for co-morbidity (a 63 year old man with multiple myeloma and cardiac amyloidosis, chronic severe heart failure, NYHA class IV). Postoperative treatment and early immunosuppressant regimen were performed according to standard protocols. The transplanted heart was assessed normal for dimensions and ventricular function at transthoracic (TT) echocardiography on post-transplant day 7. Coronary artery disease was ruled out at coronary angiography one month after transplant; left ventriculography showed normal global and segmental LV function of the transplanted heart.
Conclusion:
For the first time stress echo was successfully used in the critical theater of screening potential donor hearts. This method is enormously more feasible, less expensive, and more environmentally sustainable than any possible alternative strategy based on stress scintigraphy perfusion imaging or coronary angiography. The selection of hearts "too good to die" on the basis of bedside resting and stress echo can be a critical way to solve the mismatch between donor need and supply.
