National Decline in Donor Heart Utilization With Regional Variability: 1995-2010

Abstract

The severe shortage of donor hearts limits the availability of transplantation for the growing population of patients with end-stage heart disease. We examined national trends in donor heart acceptance for transplant. OPTN data were analyzed for all potential adult cardiac organ donors between 1995 and 2010. Donor heart disposition was categorized as transplanted, declined for transplant or other. We studied changes in the probability of donor heart acceptance according to demographic and clinical characteristics, nationwide and by UNOS region. Of 82 053 potential donor hearts, 34% were accepted and 48% were declined (18% used for other purposes). There was a significant decrease in donor heart acceptance from 44% in 1995 to 29% in 2006, and subsequent increase to 32% in 2010. Older donor age, female sex and medical co-morbidities predicted non-acceptance. Donor age and co-morbidities increased during the study period, with a concomitant decrease in acceptance of hearts from donors with undesirable characteristics. Overall, predictors of heart non-use were similar across UNOS regions, although utilization varied between regions. Regional variation suggests a potential to improve heart acceptance rates in under-performing regions, and supports research and policy efforts aimed at establishing evidence-based criteria for donor heart evaluation and acceptance for transplantation.

Donor selection in the modern era

“…Since initial suggestions that "male cardiac donors should probably be under the age of 35 and female donors under 40 years" (1), a wealth of studies, mainly based on single-center cohorts and national registry data, have been published that have challenged prior assumptions about donor heart selection. Current guidelines for heart selection, however, remain very broad and do not address many issues encountered in routine donor selection (2), thus creating highly variable selection patterns among centers (3). Donor selection remains a challenging and multifactorial decision that is influenced by imperfect donor information (and lack of data on how to interpret this information), a potential candidate's medical urgency, donor-recipient match considerations, and institutional risk tolerance.…”

A New Animal Model for Investigation of Mechanical Unloading in Hypertrophic and Failing Hearts: Combination of Transverse Aortic Constriction and Heterotopic Heart Transplantation

“…Due to global organ shortage and groundbreaking developments in mechanical circulatory support, the number of heart transplantations declined and the number of implanted left ventricular assist devices (LVAD) markedly increased over the last decade [3][4][5]. Since 2010, 100% of patients in need for destination therapy, registered in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), received continuous-flow (CF) pumps.…”

Role of cardiovascular imaging in selection of donor hearts

“…With the advent of more powerful imaging techniques such as real time 3D echocardiography and cardiac magnetic resonance imaging organ screening should become more efficient if these techniques are used in a systematic fashion. In a recent retrospective analysis of the United Network of Organ Sharing database Khush et al [1] showed that the percentage of donor hearts accepted for transplant decreased from 44% in 1995 to 29% in 2006 with an increase to 32% in 2010. Though increase in rejection rate of donor hearts has been based on age and co morbidities there are no evidence based guidelines to support this.…”

“…Though increase in rejection rate of donor hearts has been based on age and co morbidities there are no evidence based guidelines to support this. Hence efforts in this direction would be helpful [1] . In another retrospective investigation only two statistically relevant causes such as death and history of diabetes have been implicated in prolonged postoperative hospital stay and increased mortality respectively [2] .…”