Impact of low donor to recipient weight ratios on cardiac transplantation
Related Experiment Video
Updated: May 9, 2026
Rat Heterotopic Abdominal Heart/Single-lung Transplantation in a Volume-loaded Configuration
Published on: May 29, 2015
Senthil Nathan Jayarajan1, Sharven Taghavi, Eugene Komaroff
1Department of Surgery, Temple University Hospital, Philadelphia, Pa.
Insights
Heart transplantation (HT) using a lower donor to recipient weight ratio (WR) is safe for sex-matched and male-to-female recipients. However, female-to-male transplants with a lower WR show reduced survival, suggesting guideline review.
Area of Science:
- Cardiology
- Transplantation Surgery
- Organ Donation
Background:
- Current International Society of Heart and Lung Transplantation guidelines recommend a donor to recipient weight ratio (WR) greater than 0.8 for adult heart transplantation (HT).
- A higher WR threshold of 0.9 is specifically recommended for female donor to male recipient HT.
Purpose of the Study:
- To evaluate the impact of donor to recipient weight ratio (WR) on survival outcomes in adult heart transplantation (HT).
- To compare outcomes between normal WR, weight ratio low (WRL), and very low weight ratio (WRVL) groups.
Main Methods:
- Analysis of the United Network for Organ Sharing database for adult HT procedures performed between 1999 and 2011.
- Patients were categorized into three groups based on WR: normal (≥0.9), WRL (0.6–0.89), and WRVL (<0.59).
- Primary outcome measured was patient survival.
Main Results:
- Of 21,928 HT patients, 66.6% had normal WR, 32.9% had WRL, and 0.6% had WRVL.
- WRL did not significantly affect survival in male-to-male, male-to-female, or female-to-female HT.
- Female-to-male HT with WRL was associated with decreased median survival (435 days) and increased mortality (HR 1.201).
Conclusions:
- Heart transplantation (HT) with weight ratio low (WRL) donors is safe for sex-matched and male-to-female recipients.
- Female-to-male HT utilizing WRL donors is linked to poorer survival outcomes.
- Revisiting current donor acceptance criteria may be necessary to expand the donor pool amid organ shortages.
Background:
International Society of Heart and Lung Transplantation guidelines for adult heart transplantation (HT) suggest a donor to recipient body weight ratio (WR) of greater than 0.8. For female to male transplants, a WR of greater than 0.9 is recommended.
Methods:
The United Network for Organ Sharing database was examined for adult HT from 1999 to 2011. Controls with a WR of 0.9 or greater (normal donor to recipient weight ratio) were compared with patients with a WR of 0.6 to 0.89 (WRL) and a WR of less than 0.59 (WRVL). The primary measured outcome was survival.
Results:
Of the 21,928 patients undergoing HT, 14,592 (66.6%) were performed with a normal donor to recipient weight ratio, 7212 (32.9%) were performed with WRL, and 124 (0.6%) were performed with WRVL. In male donor to male recipient, male donor to female recipient, and female donor to female recipient HT, the use of WRL did not influence median survival (P = .3621) and was not associated with increased mortality (P = .7273). In female donor to male recipient HT, WRL was associated with decreased median survival (435 days, P = .0241) and was associated with increased mortality (hazard ratio, 1.201; P = .0383).
Conclusions:
HT can be safely performed using WRL donors between sex-matched and male to female transplants. However, in female to male transplants, WRL donors are associated with decreased survival. Although clinical circumstances will guide decision making, consensus criteria may be revisited to liberalize the pool of acceptable donors in an era of unprecedented donor shortage.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...