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Ventricular dysfunction associated with brain trauma is cause for exclusion of young heart donors
M Godino1, M Lander, A Cacciatore
1Instituto Nacional de Donación y Transplante, Hospital de Clínicas, Montevideo, Uruguay. mario333@mednet.org.uv
Insights
Hemodynamic dysfunction is the primary reason for excluding potential heart donors, particularly in younger patients with cranial trauma. Identifying risk factors for this dysfunction is crucial for expanding the donor pool.
Area of Science:
- Cardiology
- Transplantation
- Neurology
Background:
- Ventricular dysfunction (VD) in brain death (BD) can be reversed, potentially increasing donor availability for cardiac transplantation.
- Understanding exclusion criteria for heart donors is vital for optimizing organ procurement.
Purpose of the Study:
- To identify and quantify reasons for excluding potential heart donors.
- To define risk factors for VD in the brain death population.
Main Methods:
- Study included 100 heart-beating potential donors, with subjects defined as younger than 50 years.
- Hemodynamic dysfunction (HD) was defined as failure to meet hemodynamic goals despite inotropic support or upon diagnosing VD.
Main Results:
- Out of 246 BD subjects, 100 were potential heart donors; 75 converted to real donors (RD), including 13 heart RD.
- HD was the main exclusion reason (34%) for non-converted donors.
- Cranial trauma was the predominant cause of death (52%) leading to exclusion.
Conclusions:
- Hemodynamic dysfunction is the leading cause of heart donor loss.
- Younger patients with cranial trauma are at higher risk for HD, impacting donor conversion rates.
Objective:
Ventricular dysfunction (VD) in the context of brain death (BD) is one medical cause that may be reversed to extend the range of donors for cardiac transplant programs. The aim of this study was to identify and quantify the causes for exclusion of potential heart donors and to define risk factors for VD among the BD population.
Materials And Methods:
This study of 100 heart-beating potential donors defined subjects as those younger than 50 years. We defined hemodynamic dysfunction (HD) as failure to achieve hemodynamic objectives despite the use of inotropic agents by protocol or upon diagnosing VD.
Results:
Among 246 BD subjects were 100 potential heart donors. Of these, 75 were transformed into real donors (RD) including 13 heart RD and 62 noncardiac RD. The conversion rate of BD subjects younger than 50 years to heart RD was 17%. When we analyzed the medical reasons for exclusion of the 62 donors who were not converted to heart RD, we observed that HD was the major cause (34%). When we analyzed the causes for exclusion related to cause of death, cranial trauma predominated (52%; P = .01; relative risk 3.5; 95% confidence interval 1.4-8.5).
Conclusion:
Hemodynamic dysfunction represented the major cause for loss of heart donors; it was associated with younger patients with cranial trauma.
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