Related Experiment Videos
Successful use of the "unacceptable" heart donor
A H Menkis1, R J Novick, W J Kostuk
1University of Western Ontario, London, Canada.
Insights
To address the donor organ shortage, transplant centers are liberalizing heart acceptance criteria. This approach expands the donor pool and maintains successful outcomes for heart transplantation.
Area of Science:
- Cardiology
- Transplantation Surgery
- Organ Donation
Background:
- The chronic shortage of donor organs significantly limits heart transplantation availability.
- Historically, donor hearts were deemed unacceptable based on age (>40 years), weight mismatch (>20%), prolonged ischemic time (>4 hours), and coronary artery disease.
Purpose of the Study:
- To evaluate the impact of liberalized donor selection criteria on heart transplantation outcomes.
- To determine if expanding donor acceptance criteria can increase organ availability without compromising patient results.
Main Methods:
- Retrospective analysis of 185 consecutive orthotopic heart transplantations.
- Examination of donor hearts previously considered unacceptable based on traditional criteria.
- Assessment of current practices involving broader donor matching criteria.
Main Results:
- A significant number of transplanted hearts did not meet historical "unacceptable" criteria.
- Liberalized criteria included accepting donors >55 years and with weight <50% of recipient.
- Expanded donor pool achieved without compromising overall heart transplant outcomes.
Conclusions:
- Liberalizing donor selection criteria is a viable strategy to increase donor organ availability.
- Broadening acceptance criteria for heart donors can expand the donor pool effectively.
- Current practices demonstrate that expanded criteria do not negatively impact heart transplantation success rates.
Abstract:
Chronic shortage of donor organs has heightened interest in new strategies for increasing donor availability. Unacceptable hearts for transplant have previously been characterized by donor age greater than 40 years, more than 20% donor/recipient weight mismatch, ischemic time more than 4 hours, and the presence of coronary artery disease. A series of 185 consecutive orthotopic heart transplants were retrospectively examined. A significant number of donor hearts used were unacceptable by one or more of the above criteria. Our current approach is to match donors to recipients using a wide range of criteria. Donors are now accepted from any location in North America. We have accepted donors more than 55 years of age and donors weighing less than 50% of the recipient's body weight. Because of the chronic shortage of donor organs, donor criteria have been effectively liberalized, thereby increasing the donor pool without compromising the overall results of heart transplantation.