The adapted Heart Donor Score.

Area of Science:

• Cardiology
• Transplantation Science
• Biostatistics

Background:

• The Heart Donor Score (HDS) is utilized in the Eurotransplant system to assess donor heart viability and predict post-transplant survival.
• Adaptation of existing predictive models is crucial for optimizing organ allocation across different international registries.

Purpose of the Study:

• To adapt the Eurotransplant Heart Donor Score (HDS) for use within the United Network for Organ Sharing (UNOS) registry.
• To evaluate the performance of the adapted HDS (aHDS) in predicting donor organ discard and patient survival.

Main Methods:

• Modification of the HDS by excluding specific covariates (valve function, left-ventricular hypertrophy) and refining "compromised history" to create the aHDS.
• Analysis of two large datasets from the UNOS registry, encompassing donor organ discard (n=70,948) and survival (n=19,279) outcomes.

Main Results:

• The aHDS demonstrated a significant association with donor organ discard (OR 2.72, c-statistic 0.937), indicating strong predictive power.
• The aHDS performed consistently across different donor age groups (<60 and ≥60 years).
• Univariate analysis showed the aHDS as a significant predictor of survival (HR 1.04), though this lost significance in multivariable models.

Conclusions:

• The adapted Heart Donor Score (aHDS) is a reliable tool for predicting donor organ discard within the UNOS system.
• The study suggests that current donor selection protocols may mitigate the negative impact of aHDS components on long-term survival.