Report From the American Society of Transplantation Conference on Donor Heart Selection in Adult Cardiac Transplantation in the United States

Abstract

Cardiac transplantation remains the only definitive treatment for end-stage heart failure. Transplantation rates are limited by a shortage of donor hearts. This shortage is magnified because many hearts are discarded because of strict selection criteria and concern for regulatory reprimand for less-than-optimal posttransplant outcomes. There is no standardized approach to donor selection despite proposals to liberalize acceptance criteria. A donor heart selection conference was organized to facilitate discussion and generate ideas for future research. The event was attended by 66 participants from 41 centers with considerable experience in cardiac donor selection. There were state-of-the-art presentations on donor selection, with subsequent breakout sessions on standardizing the process and increasing utilization of donor hearts. Participants debated misconceptions and established agreement on donor and recipient risk factors for donor selection and identified the components necessary for a future donor risk score. Ideas for future initiatives include modification of regulatory practices to consider extended criteria donors when evaluating outcomes and prospective studies aimed at identifying the factors leading to nonacceptance of available donor hearts. With agreement on the most important donor and recipient risk factors, it is anticipated that a consistent approach to donor selection will improve rates of heart transplantation.

Donor selection in the modern era

“…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. To date, a number of consensus statements (4,5) and risk models (6,7) have been published in an attempt to codify knowledge around donor heart selection. What we know is that more patients are waiting for heart transplantation every year, that there is a positive association between time spent on the waitlist and mortality (8) and that the criteria used for donor heart selection must be questioned, challenged, and expanded in order to meet the evergrowing demand for heart transplantation.…”

Variability in donor selection among pediatric heart transplant providers: Results from an international survey

“…The data presented from this international survey represent the most in‐depth assessment of pediatric donor heart acceptance practices to date. Similar to the adult experience, these data highlight the variability that exists among pediatric cardiac transplant providers in the evaluation of potential donors. This variation is likely multifactorial, indicating a lack of robust scientific evidence and demonstrating the evolution of practice based on clinical experience.…”

“…The reasons for refusal of donor offers are complex, and there is no clear consensus on what makes a donor “acceptable.” Reported factors associated with donor utilization include donor gender, age, blood type, meeting CDC “high‐risk” criteria, EF, and donor inotropic support . Efforts in adult heart transplantation have been undertaken to achieve consensus on what makes a donor acceptable, and have highlighted a dramatic lack of standardization among clinicians and centers …”

The utility of serial echocardiograms for organ procurement in brain death

“…Heart transplantation rates are limited by a shortage of donor hearts . This shortage depends not only on left ventricular dysfunction but it is also magnified by other factors.…”

“…Heart transplantation rates are limited by a shortage of donor hearts. 1 This shortage depends not only on left ventricular dysfunction but it is also magnified by other factors. Many hearts are discarded due, both by an variability in morphofunctional and dynamic evaluation at the donor centers, resulting in conservative interpretation of the standards of donor selection by transplant centers.…”