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Standard criteria for an acceptable donor heart are restricting heart transplantation
V Jeevanandam1, S Furukawa, T W Prendergast
1Section of Cardiothoracic Surgery, Temple University Health Sciences Center, Philadelphia, Pennsylvania, USA.
Insights
Expanding donor heart criteria significantly increases heart transplantations. This study found no compromise in recipient outcomes, demonstrating the safety of using hearts from donors with expanded criteria, including age and medical factors.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- The scarcity of suitable donor organs presents a significant limitation for heart transplantation procedures.
- Current donor selection criteria are restrictive, leading to organ shortages and prolonged waiting times for recipients.
Purpose of the Study:
- To evaluate the safety and efficacy of expanding donor suitability criteria for heart transplantation.
- To determine if utilizing hearts from donors with non-standard characteristics impacts recipient survival and outcomes.
Main Methods:
- A retrospective analysis of 196 heart transplantations performed between 1992 and 1995.
- Donors were categorized into two groups: standard criteria (Group A, n=113) and expanded criteria (Group B, n=83).
- Expanded criteria included donors >50 years, myocardial dysfunction, undersized organs, extended ischemic times, positive blood cultures, hepatitis C antibodies, and conduction abnormalities.
Main Results:
- Thirty-day mortality rates were comparable between groups: 6.2% in Group A and 6.0% in Group B.
- At 12 months, recipient survival and hemodynamic indices were similar across both groups.
- Hepatitis C transmission occurred in 5 of 16 recipients of hepatitis C-positive hearts, with mild hepatitis observed.
Conclusions:
- Expanding donor suitability criteria for heart transplantation can significantly increase the number of available organs.
- This expansion does not appear to compromise short-term or long-term recipient outcomes.
- The study supports a broader approach to donor selection in heart transplantation to address organ scarcity.
Background:
The lack of satisfactory donor organs limits heart transplantation. The purpose of this study was to determine whether the criteria for suitability of donors may be safely expanded.
Methods:
One hundred ninety-six heart transplantations were performed on 192 patients at our institution from January 1992 to 1995 and were divided into two groups. Group A donors (n = 113) conformed to the standard criteria. Group B donors (n = 83) deviated by at least one factor and consisted of the following: 16 hearts from donors greater than 50 years of age, 33 with myocardial dysfunction (echocardiographic ejection fraction = 0.35 +/- 0.10, dopamine level exceeding 20 micrograms.kg-1.min-1, and resuscitation with triiodothyronine), 33 undersized donors with donor to recipient weight ratios of 0.45 +/- 0.04, 48 with extended ischemic times of 297.4 +/- 53.6 minutes, 25 with positive blood cultures, 16 with positive hepatitis C antibody titers, and 7 with conduction abnormalities (Wolff-Parkinson-White syndrome, prolonged QT interval, bifascicular block).
Results:
Thirty-day mortality was 6.2% (7/113) in group A and 6.0% (5/83) in group B. Mortality in group A was attributed to 3 patients with myocardial dysfunction, 2 with infection, 1 with acute rejection, and 1 with pancreatitis; group B had 2 with myocardial dysfunction, 1 with infection, 1 with aspiration, and 1 with bowel infarction. At 12 months, survival and hemodynamic indices were similar between the groups. Of the 16 recipients with hepatitis C-positive hearts, 5 have become hepatitis C positive with mild hepatitis (follow up, 6 to 30 months).
Conclusions:
Expanding the criteria for suitability of donor hearts dramatically increases the number of transplantations without compromising recipient outcome.