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Published on: June 6, 2025
Evolving Characteristics of Heart Transplantation Donors and Recipients: JACC Focus Seminar
Ersilia M DeFilippis1, Kiran K Khush2, Maryjane A Farr3
1Columbia University Irving Medical Center, New York, New York, USA.
Insights
To address the shortage of donor hearts for transplantation (HT), researchers are exploring underutilized donors and innovative surgical techniques. These advancements aim to increase organ availability and improve outcomes for heart failure patients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Innovation
Background:
- Increasing burden of end-stage heart failure necessitates expanded donor organ availability.
- Traditional donor criteria limit the pool of viable organs for heart transplantation (HT).
Purpose of the Study:
- To discuss recent trends in donor and recipient phenotypes for successful HT.
- To explore evolving surgical strategies and future directions in heart transplantation.
Main Methods:
- Utilizing hearts from previously underutilized donors (e.g., hepatitis C positive, older age, left ventricular dysfunction, cocaine use history).
- Implementing advanced surgical techniques like donation after circulatory death (DCD) and ex vivo normothermic heart perfusion.
- Employing controlled hypothermic preservation for extended organ transport and reduced allograft dysfunction.
Main Results:
- Expanded donor pool through acceptance of marginal and previously excluded donors.
- Improved organ preservation and extended procurement distances.
- Adaptation to evolving recipient profiles influenced by updated allocation policies.
Conclusions:
- Innovative donor selection and surgical preservation techniques are crucial for expanding heart transplantation.
- These advancements offer hope for improving outcomes in the growing population of heart failure patients.
- Future research should focus on further optimizing donor utilization and recipient management strategies.
Abstract:
Although the burden of end-stage heart failure continues to increase, the number of available organs for heart transplantation (HT) remains inadequate. The HT community has been challenged to find ways to expand the number of donor hearts available. Recent advances include use of hearts from donors infected with hepatitis C virus as well as other previously underutilized donors, including those with left ventricular dysfunction, of older age, and with a history of cocaine use. Concurrently, emerging trends in HT surgery include donation after circulatory death, ex vivo normothermic heart perfusion, and controlled hypothermic preservation, which may enable procurement of organs from farther distances and prevent early allograft dysfunction. Contemporary HT recipients have also evolved in light of the 2018 revision to the U.S. heart allocation policy. This focus seminar discusses recent trends in donor and recipient phenotypes and management strategies for successful HT, as well as evolving areas and future directions.
