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Updated: Aug 2, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Routine screening of donor hearts by coronary angiography is feasible
O Grauhan1, C Wesslau, R Hetzer
1Deutsches Herzzentrum Berlin, Region Norlost, Berlin, Germany. grauhan@dhzb.de
Insights
Screening older heart donors with angiography significantly reduces the risk of early graft failure. This practice is logistically and financially feasible, improving outcomes after heart transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Diagnostics
Background:
- Donor heart shortages necessitate expanded acceptance criteria, with increasing numbers of older donors.
- Pre-existing coronary atherosclerosis (CAS) transmission via transplantation is a significant risk factor.
- Transmitted CAS increases the risk of early graft failure following heart transplantation (HTX).
Purpose of the Study:
- To evaluate the feasibility and impact of routine donor angiography for heart transplantation.
- To reduce the incidence of early graft failure caused by transmitted coronary atherosclerosis.
Main Methods:
- Implementation of a guideline for mandatory donor angiography for individuals over 40 years old in the DSO-NO region starting May 2003.
- Assessing the availability of angiography facilities in donor hospitals.
- Analyzing the logistical and financial implications of donor screening.
Main Results:
- Angiography screening increased from <5% to 85% for donors over 40 in the DSO-NO region post-guideline implementation.
- 70% of donor hospitals had angiography facilities, covering 90% of donors.
- Cost savings were realized through reduced fruitless missions, with donor angiograms costing approximately €800 versus €5,000 for unfruitful missions.
Conclusions:
- Comprehensive angiographic donor screening is logistically and financially viable.
- Routine screening effectively reduces the risk of early graft failure in heart transplant recipients.
- This approach enhances the safety and success rates of heart transplantation.
Background:
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.
Methods:
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.
Results:
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.
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