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Marginal donor grafts in heart transplantation: lessons learned from 25 years of experience
Thorsten Wittwer1, Thorsten Wahlers
1Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany. Th.Wittwer-Md@t-online.de
Insights
To address donor organ shortage, this review explores liberalizing criteria for
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Donation
Background:
- Heart transplantation is a vital treatment for end-stage heart failure.
- Severe donor organ shortage limits the number of heart transplantations performed.
- Optimal utilization of available donor organs is crucial for increasing graft availability.
Purpose of the Study:
- To review literature on definitions and experiences with marginal donor hearts.
- To critically discuss controversies surrounding the liberalization of donor criteria.
- To provide an overview of modern cardiac allograft acceptance strategies.
Main Methods:
- Literature review of studies on marginal donor hearts.
- Critical analysis of donor selection criteria.
- Synthesis of data based on 25 years of heart transplantation experience.
Main Results:
- Evidence suggests that 'standard' donor criteria can be liberalized.
- Accepting 'marginal donors' can significantly expand the donor pool.
- This approach aims to increase the availability of suitable donor organs.
Conclusions:
- Liberalizing donor criteria is a key strategy to overcome organ shortages.
- A modern concept of cardiac allograft acceptance is evolving.
- This approach enhances graft availability for heart transplantation patients.
Abstract:
Heart transplantation represents an established procedure in end-stage heart failure patients and results in satisfying long-term results. However, this surgical therapy is continuously limited by severe and progredient donor organ shortage in the last years. Therefore, adequate and optimal utilization of all suitable donor organs is mandatory to increase graft availability. Evidence exists that certain 'standard' donor criteria can be significantly liberalized to increase the available donor pool by accepting 'Marginal Donors' who would, under conventional transplant guidelines, be declined as potential organ donors. The aim of this study was to review the available literature with regard to definitions and experiences with 'marginal' donor hearts and to discuss critically the controversies of numerous entities of donor criteria, which might be successfully liberalized. This review is thought to give an up-to-date overview of a modern concept of cardiac allograft acceptance based on a 25-year experience with heart transplantation.
