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Reasons for refusing a donor heart for transplantation in Brazil
André Feldman1, César Augusto Guimarães Marcelino2, Layse Beneli Prado1
1Dante Pazzanese Institute of Cardiology, Organ Procurement Organization, São Paulo, Brazil.
Insights
Donor heart refusal is common, with older age being the primary reason. Improving donor heart utilization through echocardiogram evaluation could enhance heart transplantation rates in Brazil.
Area of Science:
- Cardiology
- Transplantation Medicine
- Public Health
Background:
- Significant advancements in heart transplantation exist, yet a gap persists between potential recipients and available viable donor hearts.
- Understanding the reasons for donor heart refusal is crucial to address this organ shortage.
Purpose of the Study:
- To investigate and analyze the primary causes for the rejection of donor hearts intended for transplantation.
- To identify factors influencing donor heart suitability in Brazil.
Main Methods:
- Retrospective analysis of donor data from an organ procurement organization in São Paulo, Brazil (2010-2012).
- Statistical analysis included Fisher's exact test, Student's t-test, and Mann-Whitney U-test.
Main Results:
- Only 7.9% of potential donors became actual heart donors.
- Older age (33.4%) was the leading cause for donor heart refusal, followed by poor medical history (14.6%) and donor cardiac arrest (8.3%).
- Significant associations were found between donor heart utilization and brain death after trauma, history of hypertension, electrocardiographic changes, and donor age.
Conclusions:
- Key reasons for donor heart refusal include older age, poor medical history, donor cardiac arrest, vasopressor use, and hemodynamic instability.
- Implementing echocardiogram evaluations may improve the conversion rate of potential donors to actual heart donors for transplantation in Brazil.
Background:
Major advances have been made in heart transplantation, but there is a discrepancy between the number of patients potentially treatable by transplantation and the limited number of viable grafts. The aim of this study was to evaluate the reasons for refusal of donor hearts.
Methods:
This was a retrospective analysis of donor data from an organ procurement organization in the state of São Paulo (Brazil) between 2010 and 2012. Fisher's exact test, Student's t-test, and the Mann-Whitney U-test were used in the statistical analysis.
Results:
Only 26 (7.9%) of 328 potential heart donors actually became donors. Most donors were men (18/26, 69.2%), Caucasians (14/26, 53.8%), and had a mean age of 23.5 yr. There were significant associations of use of donor hearts with the variables: brain death after trauma (p = 0.002), history of hypertension (p = 0.001), electrocardiographic changes (p = 0.007), and age (p = 0.001). Older age (n = 101, 33.4%) was the main reason for refusal of donor hearts, followed by poor medical history (n = 44, 14.6%), cardiac arrest of the donor during donor care (n = 25, 8.3%), use of vasopressor drugs (n = 23, 7.6%), and hemodynamic instability (n = 20, 6.6%).
Conclusions:
Age, poor medical history, cardiac arrest, use of vasopressors, and hemodynamic instability were the most prevalent reasons for refusal of donor hearts. Echocardiogram evaluation is a potential intervention to improve heart transplantation conversion in Brazil.
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