Heart Transplant Donor Selection Guidelines: Review and Recommendations

Area of Science:

• Cardiology
• Transplant Surgery
• Immunology

Background:

• Heart transplant waiting lists exceed donor availability, driving the need for expanded donor criteria.
• Current institutional criteria for identifying marginal donors vary significantly, impacting donor pool utilization.
• Advancements like donation after circulatory death (DCD) necessitate re-evaluation of established donor selection protocols.

Purpose of the Study:

• To review current literature on extended donor criteria for heart transplantation.
• To analyze the impact of donor selection on heart transplant outcomes.
• To propose a model for optimizing donor heart selection.

Main Methods:

• Systematic literature review of studies on extended donor criteria in heart transplantation.
• Analysis of International Society of Heart and Lung Transplant (ISHLT) 2020 report findings.
• Evaluation of newer donor types, including donation after circulatory death (DCD).

Main Results:

• Existing literature supports and challenges the ISHLT 2020 report's emphasis on donor selection criteria.
• Predictive models from international databases show limited efficacy in predicting individual center outcomes.
• Donor risk factors and their association with transplant success require further investigation.

Conclusions:

• Optimizing donor selection is crucial for improving heart transplant outcomes.
• Standardized and updated criteria for extended and DCD donors are needed.
• Further research into donor risk factor associations will refine donor heart selection models.