Predictors of Donor Heart Utilization for Transplantation in United States

Area of Science:

• Transplantation Science
• Organ Donor Management
• Biostatistics

Background:

• Heart transplantation (HTx) rates in the U.S. have stagnated at approximately 2,500 annually.
• Optimizing donor organ use is crucial to expand transplantation therapy access for patients awaiting organs.
• The United Network of Organ Sharing (UNOS) deceased donor database (DCD) provides a valuable resource for evaluating donor factors.

Purpose of the Study:

• To evaluate donor factors that predict the utilization of donor hearts for HTx.
• To identify opportunities for increasing the donor heart pool through improved selection criteria.

Main Methods:

• A multivariate logistic regression model was developed using demographic and clinical data from the UNOS DCD (2005-2014).
• Donors with complete data were analyzed, excluding hearts not recovered due to consent issues or for non-transplantation reasons.
• The model predicted donor heart use for HTx, assigning probabilities to identify eligible but unused donor hearts.

Main Results:

• Out of 80,782 donors, 23,606 (29%) were used for HTx. A significant proportion (48%) of donor hearts were not used due to poor organ function, donor medical history, or refusal by all programs.
• The logistic regression model identified significant predictors of donor heart utilization.
• Approximately 3,070 donors with HTx-eligible hearts were identified as unused due to poor function (28%), program refusal (15%), or recipient location issues (9%).

Conclusions:

• An objective, donor-factor-based system can effectively predict donor heart usability for HTx.
• Implementing such a system has the potential to increase the availability of donor hearts within the existing donor pool.
• Improved donor heart utilization can significantly impact the number of heart transplantations performed annually.