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A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Great variability in donor heart acceptance practices across the United States
1Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California.
Insights
Donor heart acceptance varies significantly across US transplant centers, impacting organ nonuse and patient wait times. Identifying factors influencing acceptance can improve donor heart utilization and reduce mortality for transplant candidates.
Area of Science:
- Cardiology
- Transplantation Surgery
- Health Services Research
Background:
- Disparities in organ acceptance practices contribute to donor heart nonuse.
- This nonuse leads to longer waiting times and increased mortality for heart transplant candidates.
Purpose of the Study:
- To investigate disparities in donor heart acceptance practices among US transplant centers.
- To examine the relationship between these practices and posttransplant outcomes.
Main Methods:
- Analysis of deceased donor heart offers from April 2007 to December 2015 using United Network for Organ Sharing data.
- Evaluation of donor, candidate, and transplant center characteristics influencing organ acceptance, offer acceptance, and organ sequence number.
- Assessment of associations with posttransplant mortality.
Main Results:
- Significant variability in donor heart acceptance practices was observed among US heart transplant centers.
- Specific donor and recipient characteristics strongly influenced acceptance decisions and organ sequence number, with inconsistencies across centers.
- Factors predicting donor heart nonuse were identified that did not correlate with increased recipient mortality.
Conclusions:
- Donor heart acceptance practices exhibit considerable variation among US transplant centers.
- Understanding factors influencing acceptance and nonuse is crucial for optimizing donor heart utilization.
- Identifying characteristics predictive of nonuse without increasing recipient mortality can guide strategies to increase the use of available donor hearts.
Abstract:
Disparities in organ acceptance practices exacerbate donor heart nonuse and lead to increased waiting times and mortality for heart transplant candidates. We studied disparities in donor heart acceptance among US transplant centers and their relations to posttransplant outcomes. Candidate, potential transplant recipient match run, and deceased donor data were obtained from the United Network for Organ Sharing. We analyzed donor, candidate, and transplant center characteristics with respect to organ acceptance, offer acceptance, number of offers before acceptance (organ sequence number), and association with posttransplant mortality. A total of 693 420 donor heart offers made between April 2007 and December 2015 were included. We identified great variability in donor heart acceptance practices among US heart transplant centers. We identified donor and recipient characteristics that were strongly associated with heart organ and offer acceptance, and organ sequence number, and identified inconsistencies among centers with respect to how these characteristics influenced acceptance decisions. Finally, we identified characteristics that were highly predictive of donor heart nonuse and were not associated with increased recipient mortality, which may guide future efforts aimed at increasing use of available hearts for transplantation.
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