Evaluating the donor pool: impact of using hearts from donors over the age of 49 years

Abstract

The shortage of hearts for transplantation has led to the use of organs from older donors in many centres. Despite the lack of coronary angiography on potential organ donors, hearts from carefully selected donors over 49 years of age have been used at this centre since 1988. In the study reported here looked at the impact of this strategy on morbidity and mortality. Between May 1988 and August 1996,400 first heart transplants were performed, 35 recipients (31 male, 4 female: age 51 f 5.9 years) received hearts from donors over 49 years of age (group 1) while 365 (310 male, 55 female; age 49 f 9.7 years) had younger donors (group 2). The mean ischaemic time was 189 min ( k 63.1) in group 1 and 180 min ( f 59.2) in group 2 (n. s.), The main aetiology of heart failure in groups 1 and 2 was coronary artery disease in 46 YO and 51 YO, and dilated cardiomyopathy in 40 YO and 45 Yo respectively (n. s.). There were no differences in the duration of stay on the intensive care unit or in hospital between the groups. One-year survival was 79 YO in group 1 and 82 Yo in group 2 (n. s.) and actuarial 5-year survival 69. YO and 67Y0, respectively. Six patients in group 1 (17 YO ) and 45 patients in group 2 (12 % ) died in the first 3 months: of these primary donor organ failure accounted for 50 YO in

Long-Term Results of Cardiac Transplantation

“…At present, 347 transplants were performed at our institution from 1991 through 2000; 30% of those recipients received marginal donors. Thirty‐day and six‐year survival rates were 91.0% and 75.0%, respectively, which is comparable to our other patients and to that reported by other centers 31‐33 …”

The policy of placing older donors into older recipients: is it worth the risk?

“… of 372 patients found the highest risk ratio of lower one‐yr survival to be in patients receiving older donor hearts (risk ratio = 2.20; p = 0.004); in the context of advanced recipient age, this study also found it to increase the risk of mortality among other factors. However, we accept that not all studies concur on the topic: Several smaller single‐center retrospective analyses have found no correlation between increased donor age and reduced survival ; this may be a function of their small numbers.…”

Heart transplantation: a history lesson of Lazarus

“…Other legislations include zero-tolerance drinking-anddriving law resulting in fewer traffic accidents with fatal victims [108] . During this time period the United Kingdom Transplant Support Service Authority demonstrated a 12% increase in the number of cardiac donors aged greater than 41 years between 1988 and 1995 [109] . The initial reluctance to use organs from older donors especially the heart was due to longstanding dogma that older hearts were thought to more susceptible to the catecholamine flood that accompanies brain death [110] .…”

“…Initial studies exploring the extended age criteria showed no significant difference in terms of left ventricular function and the incidence of infection and rejection [109,113] . The risk of dying on the waiting list outweighed that of receiving an organ from an older donor [114] .…”