Left Ventricular Dysfunction Associated With Brain Death: Results From the Donor Heart Study.

Area of Science:

• Cardiology
• Transplantation Medicine
• Critical Care Medicine

Background:

• Left ventricular dysfunction (LVD) in potential heart donors meeting brain death criteria often leads to donor heart nonuse.
• The incidence and pathophysiology of LVD in this population remain poorly understood.
• The Donor Heart Study (DHS) aimed to resolve these unknowns through a multisite prospective cohort study.

Purpose of the Study:

• To determine the incidence and characteristics of left ventricular dysfunction in potential organ donors.
• To assess the reversibility of LVD in brain-dead donors.
• To evaluate the association between LVD, donor heart acceptance, and recipient outcomes.

Main Methods:

• Enrolled 4333 potential donors by neurologic determination of death across 8 US organ procurement organizations.
• Performed serial transthoracic echocardiograms (TTEs) to assess left ventricular ejection fraction (LVEF) and regional wall motion abnormalities.
• Defined LVD as LVEF <50%, with reversibility if LVEF >50% on a subsequent TTE.

Main Results:

• Initial TTEs in 3794 donors revealed LVD in 13% (493 donors).
• LVD was associated with younger age, underweight status, and elevated NT-proBNP and troponin levels.
• Of 224 donors with initial LVD, 58% showed reversible dysfunction; 60% of hearts with normal function were accepted vs. 56% with reversible LVD and 24% with nonreversible LVD.

Conclusions:

• Left ventricular dysfunction is common in brain-dead donors and can be reversible.
• Findings can inform donor evaluation and heart acceptance decisions.
• Donor LVD, reversible or not, did not impact 1-year recipient survival.