Expanding Selection Criteria to Repairable Diseased Hearts to Meet the Demand of Shortage of Donors in Heart Transplantation

Abstract

Heart transplant surgery is considered the destination therapy for end-stage heart disease. Unfortunately, many patients in the United States of America who are eligible candidates for transplants cannot undergo surgery due to donor shortage. In addition, some donors' hearts are being labeled as unacceptable for transplant surgery because of the rigorous and restricted rules placed on the approval process of using a donor's heart. Over the last few decades, the rising discrepancy between the scarcity of donor hearts and the demand for such organs has led to the discussion of expanding the donor heart selection criteria. A softer view on using marginal hearts for transplants would help those on the waitlist to receive a heart transplant. Marginal hearts that contain the hepatitis c virus (HCV), COVID-19, older age, or repairable heart defects have become viable options to use for a heart transplant. Also, the prioritization based on the new heart allocation system would help efficiently decide which recipients would be the first to get a donor's heart. Recently there has been a consensus to broaden the eligibility of donor's hearts by accepting valvular abnormalities, coronary artery disease, and congenital abnormalities. This review highlights some of those expansions in selection criteria in particular using repairable hearts, which could be fixed in the operating room on the back table before transplantation.

Expanding the Criteria for Heart Transplantation Donors: A Review of DCD, Increased Ischemic Times, HCV, HIV, and Extended Criteria Donors

“…While initially deemed an absolute contraindication at the beginning of the pandemic, the continued transmission of the virus in many regions around the world has necessitated rethinking the use of these organs. This stance has been supported with a case series reporting on 5 successful COVID-19+ transplants without viral transmission to the recipient [168,170].…”

“…As the transplant community has begun to increasingly utilize expanded criteria donor hearts with good outcomes, there has been an effort to re-consider other contraindications to donation. There have been several case reports of transplants using donor hearts with significant valvular or congenital heart disease, with surgeons performing repairs on the back table and achieving acceptable shortterm outcomes [168,169]. Another potential area of expansion is the use of COVID-19 positive donor organs.…”

Aortic Valve Replacement and Tricuspid Valve Repair Five Years After Orthotopic Heart Transplantation in an Adult Patient

“…Graft complications, such as allograft coronary artery disease or valvular dysfunction, can be detrimental to the quality of life of the patient, which may become refractory to medical therapy and require surgical correction. Retransplantation may not be an option for many of these patients, mostly due to a shortage of donor hearts [ 2 ]. Thus, when feasible, conventional operations to correct structural abnormalities in previously transplanted hearts are considered more frequently.…”