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What Number Are We?

David A Baran1, Hannah Copeland2, Jack Copeland3

  • 1Advanced Heart Failure Center, Sentara Heart Hospital, Norfolk, VA (D.A.B.).

Circulation. Heart Failure
|May 21, 2019
PubMed
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Organ donor sequence numbers (DSN) indicate recipient rank. This study found no difference in heart transplant survival outcomes regardless of DSN, suggesting an opportunity to increase transplants.

Area of Science:

  • Transplant Surgery
  • Organ Donation
  • Public Health Policy

Background:

  • The United Network for Organ Sharing (UNOS) implemented a new donor notification system in 2007.
  • This system assigns a donor sequence number (DSN) to indicate a recipient's position for a specific donor.
  • The impact of higher DSNs on transplant outcomes remained unclear.

Purpose of the Study:

  • To investigate whether heart transplant recipients from higher donor sequence numbers (DSNs) experience equivalent survival outcomes compared to those from lower DSNs.
  • To analyze the characteristics of donors and recipients associated with different DSN cohorts.
  • To assess the implications of DSN allocation on transplant volume.

Main Methods:

  • Analysis of the United Network for Organ Sharing database from May 2007 to March 2014.
Keywords:
adultdatabaseheart transplantationsurvival

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  • Categorization of donor sequence numbers (DSNs) into sequential cohorts (e.g., 1-5, 6-10).
  • Kaplan-Meier survival analysis comparing outcomes across different DSN groups for adult de novo heart transplants.

    • Main Results:

    • A total of 12,363 adult de novo heart transplants were analyzed, with a median DSN of 3.
    • Increasing DSN cohorts were associated with older recipients, longer ischemic times, greater donor-recipient distance, and older donors with poorer characteristics (e.g., lower ejection fraction, comorbidities).
    • No significant difference in 1-year or 5-year survival rates was observed across various donor sequence number (DSN) groups.

    Conclusions:

    • The donor sequence number (DSN) system primarily allocates donors within a close geographic range and low sequence numbers.
    • Higher DSNs do not appear to negatively impact heart transplant recipient survival.
    • Utilizing donors with higher DSNs presents a viable strategy to potentially increase heart transplant volumes.