Systematic donor selection review process improves cardiac transplant volumes and outcomes

Smith, Jason W.; O’Brien, Kevin D.; Dardas, Todd; Pal, Jay D.; Fishbein, Daniel P.; Levy, Wayne C.; Mahr, Claudius; Masri, Sofia Carolina; Cheng, Richard K.; Stempien‐Otero, April; Mokadam, Nahush A.

doi:10.1016/j.jtcvs.2015.08.081

Cited by 34 publications

(22 citation statements)

References 26 publications

(31 reference statements)

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“…Indeed, by systematically reviewing donor turndown events, some centers have been able to reduce variability and increase confidence in expanded criteria for donor acceptance with excellent posttransplantation outcomes. 9 Although there were no differences in the outcomes of high DSN and standard DSN recipients in our study, the recipient profiles of outcomes were no different between the study groups up to 1 year following transplantation, longer-term follow-up is necessary to further delineate the appropriateness of transplanting select high DSN grafts.…”

Section: Discussioncontrasting

confidence: 54%

“…This suggests that high DSN grafts should not be rejected a priori due to their elevated DSN, and that transplantation centers may be able to increase donor utilization by at least considering high DSN graft offers for their wait‐listed patients. Indeed, by systematically reviewing donor turndown events, some centers have been able to reduce variability and increase confidence in expanded criteria for donor acceptance with excellent post‐transplantation outcomes …”

Section: Discussionmentioning

confidence: 99%

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Utilization of high donor sequence number grafts in cardiac transplantation

Squiers

DiMaio

Saracino

et al. 2017

Clinical Transplantation

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Donor sequence number (DSN) represents the number of candidates to whom a graft was offered and declined prior to acceptance for transplantation. We sought to investigate the outcomes of patients receiving high DSN grafts. Consecutive isolated adult cardiac transplantations performed at a single-center were reviewed. Recipients were grouped into standard (≤75th percentile) DSN and high (>75th percentile) DSN. A previously validated donor risk index was used to quantify the risk associated with donor grafts, and recipient outcomes were assessed. Overall, 254 patients were included: 194 standard DSN (range 1-79) and 60 high DSN (range 82-1723). High DSN grafts were harvested at greater distance (P < .001) with increased ischemia time (P < .001), resulting in a modest increase in donor risk index (1 point median difference, P = .014). High DSN recipients were less frequently listed as UNOS status 1A (P < .001). Despite a nonsignificant trend toward increased in-hospital/30-day mortality in high DSN recipients, there were no differences in primary graft dysfunction or 1-year survival (high DSN 89% vs standard DSN 88%, P = .82). After adjustment for risk factors, high DSN was not associated with increased 1-year mortality (hazard ratio 1.18, 95%-CI 0.54-2.58, P = .68).

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Utilization of high donor sequence number grafts in cardiac transplantation

Squiers

DiMaio

Saracino

et al. 2017

Clinical Transplantation

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“…125 Donor call responsibilities also vary and the criteria used to gauge a potential donor vary depending on provider background (i.e., surgeon vs cardiologist). Some centers have instituted a retrospective review of all donor offers, 15 potentially increasing transparency of donor acceptance practices within a center that may help to offset omission bias that exists. Geography likely plays a significant role in donor acceptance.…”

Section: Programmatic Factorsmentioning

confidence: 99%

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

Kirk

Dipchand

Davies

et al. 2020

The Journal of Heart and Lung Transplantation

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“…Various reasons for low heart acceptance rates have been proposed, including expectations of poor posttransplant survival based upon perceived donor risk factors, anticipated interactions between donor and recipient characteristics, and a reluctance to accept a “high‐risk” donor heart for a clinically stable recipient or a recipient with uncomplicated, durable mechanical circulatory support. A single‐center effort to liberalize donor heart acceptance criteria at the University of Washington, however, led to an increase in use of available donor hearts within the region from 46% to 75%, with an accompanying decrease in waitlist mortality from 17% to 12%, while maintaining 90% recipient 1‐year survival …”

Section: Discussionmentioning

confidence: 99%

Great variability in donor heart acceptance practices across the United States

Khush

Ball

2020

American Journal of Transplantation

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Disparities in organ acceptance practices exacerbate donor heart nonuse and lead to increased waiting times and mortality for heart transplant candidates. We studied disparities in donor heart acceptance among US transplant centers and their relations to posttransplant outcomes. Candidate, potential transplant recipient match run, and deceased donor data were obtained from the United Network for Organ Sharing. We analyzed donor, candidate, and transplant center characteristics with respect to organ acceptance, offer acceptance, number of offers before acceptance (organ sequence number), and association with posttransplant mortality. A total of 693 420 donor heart offers made between April 2007 and December 2015 were included. We identified great variability in donor heart acceptance practices among US heart transplant centers. We identified donor and recipient characteristics that were strongly associated with heart organ and offer acceptance, and organ sequence number, and identified inconsistencies among centers with respect to how these characteristics influenced acceptance decisions. Finally, we identified characteristics that were highly predictive of donor heart nonuse and were not associated with increased recipient mortality, which may guide future efforts aimed at increasing use of available hearts for transplantation.

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Systematic donor selection review process improves cardiac transplant volumes and outcomes

Abstract: The simple process of systematically reviewing donor turndown events as a group tended to reduce variability, increase confidence in expanded criteria for donors, and resulted in improved donor organ utilization and transplant volumes.

Cited by 34 publications

References 26 publications

Utilization of high donor sequence number grafts in cardiac transplantation

Utilization of high donor sequence number grafts in cardiac transplantation

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

Great variability in donor heart acceptance practices across the United States

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