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Using "unsuitable" hearts for transplantation

D R Wheeldon1, C D Potter, M Jonas

  • 1Transplant Unit, Papworth Hospital Trust, Cambridge, UK.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 1, 1994
PubMed
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Donor management is crucial for heart transplantation. A hormone-based resuscitation protocol successfully utilized previously unsuitable donors, yielding transplantable organs and maintaining good patient outcomes.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Critical Care

Background:

  • Donor availability is a significant limitation in heart transplantation.
  • Many potential donors initially fall outside established organ acceptance criteria.
  • Optimizing donor organ utilization is essential to meet transplantation demand.

Purpose of the Study:

  • To evaluate the efficacy of a hormone-based pharmacological resuscitation protocol for marginal heart donors.
  • To assess the impact of this protocol on organ utilization and transplant outcomes.
  • To determine if aggressive donor management can maintain transplant activity without compromising patient survival.

Main Methods:

  • Initial screening of 100 heart donors identified 21 outside minimum criteria (MAP >60 mmHg, CVP <12 mmHg, PCWP <12 mmHg, LVSWI >15 g.m., inotropes <5 mcg/kg/min).

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  • Further assessment with invasive monitoring excluded an additional 14 donors.
  • A hormone-based pharmacological resuscitation protocol was implemented for marginal donors.
  • Organ utilization and recipient outcomes were tracked post-transplantation.

    • Main Results:

    • Following resuscitation, 30 previously unsuitable donors yielded 19 transplantable hearts and 11 heart-lung blocks.
    • The protocol successfully utilized organs from donors with suboptimal hemodynamic parameters and those requiring inotropes.
    • Recipient survival at 4-25 months post-transplant was 83.3% (25 out of 30).
    • Early mortality rates decreased significantly over the study period (16.2% in 1989 to 6.8% in 1991).

    Conclusions:

    • A hormone-based resuscitation protocol can effectively expand the donor pool for heart transplantation.
    • Aggressive and focused donor management improves organ utilization without negatively impacting patient survival.
    • This strategy is vital for maintaining transplant activity and addressing organ shortages.