Effect of left ventricular dysfunction on utilization of donor hearts

Area of Science:

• Cardiology
• Transplant Surgery
• Organ Donation

Background:

• Left ventricular dysfunction (LVD) is a common reason for excluding potential cardiac donors.
• Recent studies suggest that hearts with LVD can be safely transplanted.
• The magnitude of non-utilization of these organs requires investigation.

Purpose of the Study:

• To investigate modern non-utilization rates of potential cardiac donors with LVD.
• To clarify the impact of recent studies on the safe transplantation of LVD hearts.
• To analyze trends in donor heart utilization over time.

Main Methods:

• Utilized the United Network for Organ Sharing (UNOS) transplant database (January 2007-June 2014).
• Included donors aged 13-59 years with available consent.
• Employed a covariates-adjusted Poisson regression model to estimate non-utilization risk for LVD.

Main Results:

• Over 60,000 donors were assessed; 34.92% of eligible hearts were transplanted.
• Left ventricular dysfunction (LVD) was the exclusive reason for non-utilization in 19.05% of cases.
• A 10% increase in LV ejection fraction decreased non-utilization risk by 20% (RR=0.80).
• Overall donor heart utilization decreased over time (p < 0.001).

Conclusions:

• Around 20% of potential cardiac donors are excluded due to LVD.
• This exclusion rate has not been influenced by studies supporting safe LVD heart transplantation.
• Further data are needed to explain the refusal of hearts with "poor function" without documented LVD (11.04%).