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Is shortage of heart donors a real problem? Insights from a Brazilian Mid-West heart transplant program
Fernando A Atik1, Felipe B M Oliveira2, Pedro H M Peres1
1Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasilia, Distrito Federal, Brazil.
Insights
Donor shortage is not limiting heart transplants in Brazil. Nonmedical reasons cause organ discard, with most donors being high-risk. Donor scoring did not affect transplant decisions.
Area of Science:
- Cardiology
- Transplantation Medicine
- Public Health
Background:
- Donor shortage is a critical issue for heart transplantation in developed nations.
- This study investigates donor availability and utilization in Brazil.
Purpose of the Study:
- To determine if donor scarcity limits heart transplantation in Brazil.
- To analyze donor profiles, refusal reasons, and their impact on transplant outcomes.
Main Methods:
- Analysis of 299 adult heart donor offers between 2012-2014.
- Calculation of European donor scoring system; high-risk defined as >17 points.
- Cox proportional hazard model for long-term mortality predictors.
Main Results:
- Donor acceptance and transplant rates were 45.8% and 19.3%.
- Nonmedical reasons accounted for 53.7% of discards.
- High-risk donors (65.5%) did not affect graft dysfunction or survival; recipient age >50 was the sole mortality predictor.
Conclusions:
- Donor shortage is not the primary barrier to heart transplantation in Mid-West Brazil.
- Organ discard is mainly due to nonmedical factors.
- Expanded donor pool utilization is standard; donor scoring does not influence transplant decisions.
Background And Aim Of The Study:
In developed countries, the shortage of viable donors is the main limiting factor of heart transplantation. The aim of this study is to determine whether the same reality applies to Brazil.
Methods:
Between January 2012 and December 2014, 299 adult heart donor offers were studied in terms of donor profiles and reasons for refusal. The European donor scoring system was calculated, being high-risk donors defined as more than 17 points. The donor scoring system was used to objectively determine the donor profile and correlate with donor acceptance and posttransplant primary graft dysfunction and recipient survival. Cox proportional hazard model was used in determining the predictors of long-term mortality.
Results:
The rates of donor acceptance and heart transplants performed were 45.8% and 19.3%, respectively. Reasons for refusal were mostly nonmedical (53.7%). The majority of donors were classified as high-risk (65.5%). Hearts from high-risk donors did not impact primary graft dysfunction (14.3% vs 10%; P = .6), neither long-term survival (P = .4 by logrank test). Recipient's age was greater than 50 years (hazard ratio, 6.02; 95% confidence interval, 2.41-16.08; P < .0001) and was the only predictor of long-term mortality.
Conclusions:
The shortage of donors is not the main limiting factor of heart transplantation in the Mid-West of Brazil. Nonmedical issues represent the main reason for organ discard. Most of the donors are classified as high risk which indicates that an expanded donor pool is a routine practice in our region, and donor scoring does not seem to influence to proceed with the transplant.
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