Moving Beyond the Perfect Donor: An Interdisciplinary Approach to Optimizing Donor Utilization

Despite a growing demand for donor hearts, more than two-thirds of viable hearts are discarded in North America. Our initiative sought to improve donor heart utilization by reviewing institutional donor acceptance practices and implementing targeted interventions.

Our aim was to increase donor heart utilization rate to 20% and reduce the rate of missed viable opportunities to ≤10% within a 12-month period, and assess the incidence of primary graft dysfunction preintervention and postintervention.

This prospective single-center study included all donor heart offers from January 1, 2021, to December 31, 2023. Donor demographics, clinical data, and utilization outcomes were collected. Missed viable opportunities were defined by criteria including left ventricular ejection fraction >50%, age <45 years, ischemic time <4 hours, and ≤20% undersizing by predicted heart mass. In January 2023, we launched a dashboard to track and display real-time utilization rates, held a Vanguard international speaker series, and introduced cardiologist/surgeon donor report cards.

Before the interventions (January 2021-December 2022), 54 of 436 (12.4%) donor offers were utilized; postintervention (January 2023-December 2023), 43 out of 233 offers (18.5%) were utilized (P = 0.038). Missed viable opportunities decreased from 19.3% (2021-2022) to 8.6% (2023) (P < 0.001). Additionally, there was a trend toward reduction in severe primary graft dysfunction (26% vs 12%, P = 0.121) postintervention.

Our interdisciplinary, multipronged interventions doubled our donor heart utilization rate and significantly reduced missed viable opportunities without compromising short-term heart transplant recipient outcomes.