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Number of donor hearts accepted for transplant declines in US
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The number of donor hearts accepted for transplantation in patients with end-stage heart disease has declined in the United States since 1995, according to recent findings.
Researchers evaluated heart transplant donor, waiting list and posttransplant survival data acquired from the Organ Procurement and Transplantation Network database. They utilized de-identified data on 82,053 organ donor candidates aged 18 to 70 years whose cases were handled between 1995 and 2010, with follow-up through March 2, 2012.
Donor hearts were categorized as follows: hearts that were authorized but not recovered for transplantation (37% of hearts in the study population); transplanted hearts (25%); hearts that were recovered, but not for transplantation (13%); hearts for which no donation request was made to next-of-kin (8%); hearts for which no authorization for recovery was given by living next-of-kin (4%); and hearts that were recovered but not transplanted (1%).
The researchers evaluated the differences between donor hearts that were accepted for transplant and those that were declined based on demographic and clinical donor characteristics, including age, sex, cause of death, left ventricular ejection fraction and presence of hypertension or diabetes.
Within the study population, 28,098 hearts were accepted and 39,529 were declined. From 1995 to 2006, acceptance declined from 44% to 29%, then increased to 32% by 2010. The number of available hearts that were declined increased consistently from 37% in 1995 to 52% in 2010.
Donor age older than 50 years, female sex, hypertension, diabetes, death due to cerebrovascular causes and left ventricular dysfunction were significantly associated with donor heart nonacceptance. Mean donor age increased from 40.3 years in 1995 to 43.2 years in 2010. The prevalence of both diabetes (3.5% of donors to 13.7%) and hypertension (23.3% to 38.9%) also increased during this time period, whereas the rate of acceptance of hearts from donors with unfavorable characteristics decreased.
Predictors of donor heart nonuse were similar across all 11 regions within the United Network of Organ Sharing. However, organ utilization varied by region, with certain regions consistently more likely to utilize donor hearts than others. The researchers wrote that these regional discrepancies highlight a need for updated consensus guidelines for donor heart acceptance, supported by evidence-based research.
“We, as a heart transplant community, are using a small fraction of available donor hearts for transplantation, and we have become more conservative over the past 15 to 20 years in terms of heart acceptance,” researcher Kiran Khush, MD, MAS, of the Stanford University School of Medicine, said in a press release. “This finding is troubling in the setting of national donor heart shortage and an ever-growing number of critically ill patients awaiting heart transplantation.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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