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Reasons for donor heart offer refusal are often unrelated to the donor itself - when, why, and the "weekend effect"
Brian Wayda1, Helen Luikart2, Yingjie Weng3
1Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
Insights
Nearly a quarter of donor heart offers are refused for reasons unrelated to the donor. Donor assessment, particularly on weekends, involves subjective factors needing further investigation for improved heart transplant rates.
Area of Science:
- Transplant Surgery
- Organ Donation
- Cardiology
Background:
- Most donor hearts offered for heart transplant (HT) in the United States are declined.
- Understanding donor-unrelated reasons for refusal is crucial for improving organ utilization.
Purpose of the Study:
- To investigate the prevalence and nature of donor-unrelated reasons for heart offer refusal.
- To examine associations between refusal reasons and offer timing (weekends vs. weekdays).
Main Methods:
- The Donor Heart Study (DHS) surveyed 4,333 adult potential heart donors from 2015-2020.
- Heart transplant centers provided reasons for declining offers, categorized into 18 distinct donor-unrelated factors.
- Statistical analysis assessed prevalences and temporal trends, including weekend/weekday differences.
Main Results:
- Donor-unrelated reasons accounted for 24.3% of declined offers.
- Recipient issues were the most common donor-unrelated reason (7%), while resource issues were rare (<1%).
- Certain reasons, like "already considering another offer" and "distance too far," increased after 2018; donor-related reasons were more frequent on weekends.
Conclusions:
- A significant portion of donor heart offer rejections stem from donor-unrelated factors.
- The observed "weekend-predominance" of certain refusal reasons suggests subjective elements in donor assessment that require further study.
Background:
Most donor hearts offered for heart transplant (HT) in the United States (US) are turned down. We aimed to understand the reasons for this - focusing on those related to the potential recipient and HT center (i.e., donor-unrelated reasons for refusal).
Methods:
The Donor Heart Study (DHS) enrolled 4,333 adult potential heart donors in US from 2015 to 2020. Separately by donor, each HT center who refused an offer for that donor was surveyed on their reason(s) for refusal. We measured the prevalences of 18 distinct donor-unrelated reasons for refusal and their association with the timing of offers (weekend vs. weekday).
Results:
Our analytic sample included 14,132 unique surveys, each representing a declined offer for one of 3,083 donors (mean per donor: 2.56; range: 1-17). Donor-unrelated reasons were cited in 24.3% (n = 3,441) of surveys; among these, recipient issues (i.e., "recipient ill) were most common (cited in 7%) while resource-related issues (e.g., "logistics", "surgeon unavailable") were rare (<1%). Neither showed a significant time trend; however, other reasons ("already considering another offer", "distance too far") did so, with an abrupt uptick after 2018. We found that several donor-related (but no donor-unrelated) reasons for refusal (e.g., left ventricular hypertrophy, social risk behaviors) were significantly more common on weekends. Their "weekend-predominance" was not explained by differences in objective donor characteristics.
Conclusions:
Nearly one quarter of donor heart offer refusals are due to donor-unrelated reasons. Weekend-predominant reasons for offer refusal signal the highly subjective nature of donor assessment and warrant further scrutiny.
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