With the limited capacity of the available donor pool and the simultaneously growing demand for heart transplantation, expanding the heart donor selection criteria as one of the ways of increasing the availability of organ transplantation, and particularly donor heart, has become a challenge. On one hand, the use of expanded criteria donors increases the number of transplants and reduces the time spent on the waiting list. On the other hand, however, it increases the risk of adverse transplant outcomes. Accordingly, high-risk donors require a more thorough objective assessment using predictive models, while organs obtained from expanded criteria donors, require optimal selection of a donor-recipient pair. Analysis of global and national studies presented in this review reveals the depth of the current problem of heart donor selection.

Organ donation and transplantation in Moscow have witnessed changes in the last decade. These changes have led not only to quantitative growth in the number of effective donors but also to fundamentally new (for Russian medical practice) characteristics of the donor pool. As a result, the selection criteria for organ donors have undergone some radical revisions. Objective: to analyze the medical and epidemiological characteristics of the pool of effective heart donors and assess their impact on selection of heart transplants. Materials and methods. In our study, we used the medical and epidemiological data of 650 brain-dead donors whose organs were procured from January 1, 2012 to December 31, 2017. Results. During the study period, the number of effective heart donors in Moscow increased from 4.4 (2012) to 11.2 (2017) per million population per year. The medical and epidemiological characteristics of the total pool of donors and the pool of heart donors underwent major changes. Among effective heart donors, there was a dynamic increase in the average age from 38.4 to 47 years, predominance of a proportion of donors with stroke 38.2 (2012) vs 83.2 (2017) and, accordingly, an increase in the frequency of such comorbid conditions, as hypertension and diabetes. Conclusion. The results presented in the study indicate a growing practice of working with expanded criteria donors. This practice is most effectively developed in the field of heart transplantation than in transplantation of other extrarenal organs. Undoubtedly, the experience under study is unique and relevant not only for the Russian Federation, but also for the world of transplantology, as it allows to provide vital assistance to patients with end-stage heart failure within a reasonable timeframe.

медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация Селекция доноров сердца -важнейший этап, от которого зависит успех трансплантации сердца. Цель исследования -создание модели оценки донорского сердца, основанной на ряде характеристик донора. Материалы и методы. В исследовании использованы данные 650 доноров со смертью головного мозга, у которых были выполнены эксплантации органов в период с 1 января 2012 года по 31 декабря 2017 года. В биноминальной логистической регрессии в качестве зависимой переменной использовался отказ от донорского сердца, в качестве факторных признаков использовались характеристики донора. В регрессионной модели для каждого донорского фактора определена величина ОШ, которая трансформирована в баллы, и сумма баллов каждого из донорских факторов, вошедших в модель, являлась оценкой донорского сердца. Предложенная модель валидизирована на выборке доноров за период с 1 января 2019 года по 31 декабря 2019 года, общим количеством 218. Результаты. В модель включены характеристики доноров -возраст, причина смерти (ЧМТ/ОНМК), ГБ и СД в анамнезе, остановка сердечной деятельности с последующим ее восстановлением, собственная патология и травматические повреждения сердца, а также показатели ЧСС, САД, лактата артериальной крови, потребности в норадреналине непосредственно перед изъятием органов. Основываясь на среднем значении суммы баллов, определены доноры низкого риска (ДНР ≤17 баллов) и доноры высокого риска (ДВР ≥18 баллов). В валидационном пуле доноров удельный вес отказов от сердца среди ДНР составил 4,1% и среди ДВР -78,6%, р < 0,0001, χ 2 Пирсона -130,9. Заключение. Представленная модель по оценке донорского сердца достаточно точно отражает вероятность использования сердца донора для трансплантации и создает условия для оптимального распределения сердечных трансплантатов, особенно от доноров высокого риска.Ключевые слова: модель оценки донорского сердца, донорские факторы риска трансплантации сердца.

The objective of the study was to investigate the evolution and trends in liver donation in the city of Moscow, with special focus on the expansion of liver donor selection criteria for transplantation.Materials and methods. The study included 1,548 effective donors (EDs) in the period from January 1, 2012 to December 31, 2020. Their basic characteristics - age and cause of death - are presented. The dynamics of changes in the age groups of donors and the dynamics of the number of >60-year-old liver donors were studied. The influence of expanded liver donor selection criteria over the dynamics of the number of transplant surgeries and patient flow on the waiting list was assessed.Results. During the study period, the number of effective liver donors (ELDs) in Moscow increased 4.7-fold. The average age of ELDs increased from 37.1 in 2012 to 48.8 in 2020. There was an absolute prevalence of donors who died from cerebrovascular accident compared with donors who died from traumatic causes, 83.4% vs 16.6%, respectively. Since 2016, there has been a progressive increase in >60-year-old liver donors; the number of such donors in 2020 reached 39, accounting for 13.6% of the total pool of EDs. The progressive growth in the number of liver transplants has significantly influenced patient movement on the waiting list. In 2012, there was a 25.2% increase in the number of liver transplants per 100 patients on the waiting list; by 2020, it had reached 86.6%.Conclusion. The results reasonably indicate an increase in liver donation and liver transplantation (LTx) in Moscow. Comparison of Russian data with those of leading foreign donor programs shows that the trends in the donor pool in the context of older age, including >60-year-old donors, and shifting causes of donor death towards cerebrovascular diseases are similar. An overall increase in donor activity and expansion of liver donor criteria contributed to an increase in the number of transplants performed per 100 patients on the waiting list, which, in turn, reduced the waiting time for a donor organ and increased the intensity of patient flow on the waiting list.