Routine screening of donor hearts by coronary angiography is feasible

Because of the shortage of donor hearts, the criteria for acceptance have been considerably extended. Meanwhile every fourth heart donor in Europe is over 50 years old. As we have previously demonstrated, transmission of preexisting coronary atherosclerosis (CAS) by means of transplantation is not rare. Transmitted CAS results in a 2- to 3-fold increased risk for early graft failure after heart transplantation (HTX). Nevertheless, in most cases donor angiograms are not considered feasible.

In May 2003 in the northeast region of the Deutsche Stiftung Organtransplantation (DSO-NO), we introduced the guideline that every donor over 40 years old must be screened by angiography.

Up to May 2003, fewer than 5% of donors had been screened by angiography; this situation is the rule in most Eurotransplant regions at present. Since May 2003 in the DSO-NO region, 85% of all donors over 40 years old were screened by angiography. Seventy percent of all donor hospitals--offering 90% of all donors--had an angiography facility. The additional costs of approximately euro 800 per donor angiogram were compensated by fewer fruitless airplane missions when CAS was diagnosed by the surgeon on the spot, which cost on average about euro 5,000 each. In conclusion, from a logistical as well as from a financial point of view, almost comprehensive angiographic donor screening is feasible. It reduces the risk of a recipient suffering from early graft failure.