Assessment of the Potential Heart Donor

Abstract

Demand for donor hearts exceeds supply, and a significant number of patients die while awaiting transplantation. Within the pool of currently unused potential donor hearts, a proportion may be suitable for transplantation but are declined due to anticipated poor function. Despite current assessment methods, in some donor hearts accepted for transplantation early graft failure develops in the recipient. Current methods of assessment are inadequate, and there is a potential for biomarkers to improve identification of satisfactory hearts for transplantation or hearts destined to fail in the recipient. Biomarkers are routinely used to diagnose and risk-stratify myocardial infarction, acute coronary syndromes, and heart failure. Some of these might facilitate donor heart assessment. Cardiac troponins, cytokines, inflammatory markers, natriuretic peptides, and intracellular proteins may each have discriminant value. This review details the current status of biomarkers in the assessment of donor hearts.

Human Leukocyte Antigen-DR Mismatch Is Associated With Increased In-Hospital Mortality After a Heart Transplant

“…In fact, the latter provides an important indication of graft function within the recipient's body 18 ; therefore, independence from this important marker is a further indication of the strength of the observed HLA-DR role in the outcomes of a heart transplant.…”

Incidence and outcome of Levitronix CentriMag support as rescue therapy for early cardiac allograft failure: a United Kingdom national study

“…Further advances in VAD technology and its clinical application may improve results. However, PGF continues to represent a transplant catastrophe and research must also focus on prevention through better donor assessment, identification of robust non-clinical risk factors in both donor and recipient (e.g., biomarkers predictive of PGF) [25] and improved myocardial protection during the transplant procedure [11].…”

The International Heart Transplant Survival Algorithm (IHTSA): A New Model to Improve Organ Sharing and Survival

“…The acceptance of the heart is usually done before a detailed organ inspection has been performed. With an improved prediction of outcome based on the characteristics of both the recipient and donor, we can have more confidence in the post-transplantation performance and it may be possible to improve survival and increase the number of organs that can be used [2]. …”