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Updated: Jun 18, 2025
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Strategies for Expanding Donors Pool in Heart Transplantation
Samuel Jacob1, Pankaj Garg1, Ishaq Wadiwala2
1Department of Cardiothoracic Surgery, Heart and Lung Transplant Program, Mayo Clinic, Jacksonville, FL 32224, USA.
Insights
The global shortage of donor hearts for transplantation is worsening despite expanded donor criteria and new technologies. Thousands die annually awaiting a heart transplant due to insufficient organ availability.
Area of Science:
- Cardiology
- Transplantation Medicine
- Regenerative Medicine
Background:
- Heart transplantation is the gold standard for end-stage heart failure.
- Increased demand for donor hearts due to improved post-transplant outcomes.
- A significant gap exists between the number of heart transplant candidates and available donor organs.
Purpose of the Study:
- To review the current state of heart donor organ shortage.
- To discuss strategies employed to expand the donor pool.
- To highlight emerging technologies and future directions in addressing organ scarcity.
Main Methods:
- Review of existing literature on heart transplantation and organ donation.
- Analysis of trends in heart transplant demand and donor organ supply.
- Evaluation of novel technologies in organ preservation and potential future solutions.
Main Results:
- Despite expanded donor criteria (e.g., hepatitis C virus positive, older donors) and improved allocation systems, organ shortage persists.
- Emerging technologies like normothermic regional perfusion and ex-vivo heart perfusion show promise but do not fully bridge the demand-supply gap.
- Thousands of patients die annually awaiting a heart transplant due to critical organ scarcity.
Conclusions:
- Current strategies are insufficient to overcome the critical shortage of donor hearts.
- Advancements in regenerative medicine and xenotransplantation are crucial for future solutions.
- Addressing the heart donor organ shortage requires continuous innovation and exploration of new frontiers in transplantation.
Abstract:
Heart transplant remains the criterion standard treatment for patients in end-stage heart failure. Improvement in the post-heart transplant outcomes in the last decade has contributed to increased demand for organs. Worldwide each year, more than 5000 heart transplants are performed and 50,000 people become candidates for heart transplant. In the last 50 years, there have been several attempts to expand donor criteria to increase the donor pool. Despite making hepatitis C virus, opioid overdose death, old age allowable and changing the allocation system, the gap between supply and demand is widening and unfortunately, thousands die every year waiting due to the critical shortage of organs. New technologies for heart donation after circulatory death have emerged, particularly normothermic regional organ perfusion and ex-vivo heart perfusion using organ care systems. However, these technologies still do not fill the gap. Continuous advancements in areas such as regenerative medicine and xenotransplantation, among others, are needed to overcome the shortage of heart donors for heart transplantation.
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