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Functional assessment and management of heart donors: a rationale for characterization and a guide to therapy
C D Potter1, D R Wheeldon, J Wallwork
1Transplant Unit, Papworth Hospital, Cambridge, United Kingdom.
Insights
Optimizing donor heart management with comprehensive monitoring safely expanded the donor pool by 30%. This strategy improves functional evaluation for better organ suitability decisions in heart transplantation.
Area of Science:
- Cardiology
- Transplant Surgery
- Anesthesiology
Background:
- Traditional donor heart evaluation relies on limited hemodynamic data and visual inspection.
- Primary graft dysfunction remains a significant cause of mortality in heart transplant recipients.
- Inadequate physiological support leads to the loss of at least 25% of potential organ donors.
Observation:
- A refined strategy for optimizing donor management has been developed over several years.
- Comprehensive perioperative invasive monitoring is central to this management regimen.
- Cardiac anesthetists manage donor care during retrieval operations.
Findings:
- The new management strategy has safely expanded the donor pool by approximately 30%.
- This approach provides a more thorough functional evaluation of donor hearts.
- It serves as a guide for management and decision-making regarding organ suitability.
Implications:
- Improved donor management can increase the availability of viable organs for transplantation.
- Enhanced functional evaluation leads to better selection of donor hearts, potentially reducing primary graft dysfunction.
- This technique offers a standardized approach to donor heart assessment, improving transplant outcomes.
Background:
Traditional methods for the functional evaluation of a donor heart have relied on superficial hemodynamic data and visual inspection of the action of the heart at sternotomy. The International Registry has continued to report significant mortality for heart transplant recipients from primary graft dysfunction that may be due to donor management, donor organ selection, organ preservation, or recipient factors. The literature reports the loss of at least 25% of potential donors because of the provision of inadequate physiologic support.
Methods And Results:
We have now spent several years in establishing and refining a strategy for optimizing donor management, which has resulted in the safe expansion of our donor pool by approximately 30%. Central to this management regimen has been the use of comprehensive perioperative invasive monitoring used by a cardiac anesthetist who takes responsibility for donor management during the retrieval operation.
Conclusion:
This article outlines the technique which has evolved for the functional evaluation of a donor heart, which is now used in our institution as a guide to management and as a basis for decision making regarding organ suitability.