Reasons for refusing a donor heart for transplantation in Brazil

“…Feldman et al 8 corroborated the low rate of donor utilization in Brazil in a cohort of very young donors (mean age of 23.5 years), mostly due to poor donor management protocols. Likewise our experience with long‐distance donors, they 8 have confirmed the unavailability of echocardiography at donor assessment. This may reduce the use of many potential grafts because of concerns regarding organ quality and recovery.…”

Section: Discussionmentioning

confidence: 90%

“…One study found that the use rates decreased by an average of 4.2% per year, from a high of 56% in 2002 to a low of 37% in 2007 11 . Feldman et al 8 corroborated the low rate of donor utilization in Brazil in a cohort of very young donors (mean age of 23.5 years), mostly due to poor donor management protocols. Likewise our experience with long‐distance donors, they 8 have confirmed the unavailability of echocardiography at donor assessment.…”

Section: Discussionmentioning

confidence: 99%

“…Economic, religious, and cultural differences amongst countries and regions in the same country prevail and they account for very different realities that explain unequal access to heart transplantation. Finally, and not least important, intensive care related to the donor is probably less developed, 8 which determines a very low rate of donor acceptance among the potential donor pool. Reasons for refusal vary considerably according to the individual transplant center, including medical and nonmedical issues.…”

Section: Introductionmentioning

confidence: 99%

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Is shortage of heart donors a real problem? Insights from a Brazilian Mid‐West heart transplant program

et al. 2020

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Background and Aim of the Study In developed countries, the shortage of viable donors is the main limiting factor of heart transplantation. The aim of this study is to determine whether the same reality applies to Brazil. Methods Between January 2012 and December 2014, 299 adult heart donor offers were studied in terms of donor profiles and reasons for refusal. The European donor scoring system was calculated, being high‐risk donors defined as more than 17 points. The donor scoring system was used to objectively determine the donor profile and correlate with donor acceptance and posttransplant primary graft dysfunction and recipient survival. Cox proportional hazard model was used in determining the predictors of long‐term mortality. Results The rates of donor acceptance and heart transplants performed were 45.8% and 19.3%, respectively. Reasons for refusal were mostly nonmedical (53.7%). The majority of donors were classified as high‐risk (65.5%). Hearts from high‐risk donors did not impact primary graft dysfunction (14.3% vs 10%; P = .6), neither long‐term survival (P = .4 by logrank test). Recipient's age was greater than 50 years (hazard ratio, 6.02; 95% confidence interval, 2.41‐16.08; P < .0001) and was the only predictor of long‐term mortality. Conclusions The shortage of donors is not the main limiting factor of heart transplantation in the Mid‐West of Brazil. Nonmedical issues represent the main reason for organ discard. Most of the donors are classified as high risk which indicates that an expanded donor pool is a routine practice in our region, and donor scoring does not seem to influence to proceed with the transplant.

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“…Rossano et al review of the UNOS database revealed that even moderately depressed LV function of the donor graft was not associated with any significant difference in survival in the recipients. Increasingly, the use of vasopressors and inotropes is not considered contraindications to organ donation . In the clinical management of the organ donor, initiation of vasopressor and inotropic support should be titrated to achieve the goals of adequate CVP, normal blood pressure for age, normal urine output, and markers of adequate tissue oxygen delivery.…”

Section: Hemodynamic Management—general Considerationsmentioning

confidence: 99%

Pediatric donor management to optimize donor heart utilization

Zimpfer¹,

Alexander

Davies

et al. 2020

Pediatric Transplantation

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Optimal management of pediatric cardiac donors is essential in order to maximize donor heart utilization and minimize the rate of discarded organs. This review was performed after a systematic literature review and gives a detailed overview on current practices and guidelines. The review focuses on optimal monitoring of pediatric donors, donor workup, hormonal replacement, and obliterating the adverse effects of brain death. The current evidence on catecholamine support and thyroid hormone replacement is also discussed. Recognizing and addressing this shall help in a standardized approach toward donor management and optimal utilization of pediatric heart donors organs. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Reasons for refusing a donor heart for transplantation in Brazil

Abstract: Age, poor medical history, cardiac arrest, use of vasopressors, and hemodynamic instability were the most prevalent reasons for refusal of donor hearts. Echocardiogram evaluation is a potential intervention to improve heart transplantation conversion in Brazil.

Cited by 5 publications

References 7 publications

ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation

ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation

Is shortage of heart donors a real problem? Insights from a Brazilian Mid‐West heart transplant program

Pediatric donor management to optimize donor heart utilization

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