School of Medicine and Health Sciences Poster Presentations
Organ Turn Down at a Single Center: Donor Heart Organ Turn Down, Is It Rational?
Poster Number
155
Document Type
Poster
Publication Date
3-2016
Abstract
Purpose of Study: Donor heart selection for heart transplantation is not standardized. Donor hearts are declined for reasons including function, size mismatch, hypertrophy, and recipient factors such as mechanical circulatory support (MCS) dependence, ventilator dependence, diabetes, renal insufficiency, donor cold ischemic time (CIT), etc. It has not been substantiated as to what factors are most prevalent in donor heart turn-down for specific recipients.
Methods Used: Between 2010 and 2015, we assessed 784 donor heart offers. We found 270 declined heart donors with a total of 307 reasons for organ decline. Poor quality was characterized by older donor age, presence of hypertension and diabetes, cardiac arrest, evidence of infection, high dosage of vasopressors/medication, etiology of death, other medical history. Duplicate offer was defined by the potential recipient being transplanted or having another donor heart offer. Human leukocyte antigen (HLA) factors were defined by unacceptable D/R HLA antigens, D/R positive crossmatches, or unavailability of serum for crossmatching. Recipient factors included the recipient refusing transplant, not being located, or too sick at time of offer. Combination transplant was defined for need of multiple organ transplants or an organ of different laterality.
Summary of Results: The most common cause for donor heart turn-down was size mismatch between donor/recipient (D/R) followed by poor quality, duplicate offer, social history/CDC risk, recipient factors, HLA factors, and combination transplant. See table.
Conclusions: A majority of donor hearts are turned down for size mismatch and not quality. These hearts are most likely used by other programs where D/R size matching is appropriate. Further investigation into donors with poor quality should be pursued as some may be viewed acceptable by other programs. A donor/recipient scoring system may be helpful to minimize turned down donor hearts.
Endpoints -- Reasons for Refusal (n=347); Size Mismatch between Donor/Recipient: 36.9% (128/347); Poor Quality: 25.6% (89/347); Duplicate Offer: 11.2% (39/347); Social History/CDC High Risk: 2.9% (10/347); Recipient Factors: 2.3% (8/347); HLA Factors: 7.5% (26/347); Combination Transplant: 2.0% (7/347).
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Open Access
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Organ Turn Down at a Single Center: Donor Heart Organ Turn Down, Is It Rational?
Purpose of Study: Donor heart selection for heart transplantation is not standardized. Donor hearts are declined for reasons including function, size mismatch, hypertrophy, and recipient factors such as mechanical circulatory support (MCS) dependence, ventilator dependence, diabetes, renal insufficiency, donor cold ischemic time (CIT), etc. It has not been substantiated as to what factors are most prevalent in donor heart turn-down for specific recipients.
Methods Used: Between 2010 and 2015, we assessed 784 donor heart offers. We found 270 declined heart donors with a total of 307 reasons for organ decline. Poor quality was characterized by older donor age, presence of hypertension and diabetes, cardiac arrest, evidence of infection, high dosage of vasopressors/medication, etiology of death, other medical history. Duplicate offer was defined by the potential recipient being transplanted or having another donor heart offer. Human leukocyte antigen (HLA) factors were defined by unacceptable D/R HLA antigens, D/R positive crossmatches, or unavailability of serum for crossmatching. Recipient factors included the recipient refusing transplant, not being located, or too sick at time of offer. Combination transplant was defined for need of multiple organ transplants or an organ of different laterality.
Summary of Results: The most common cause for donor heart turn-down was size mismatch between donor/recipient (D/R) followed by poor quality, duplicate offer, social history/CDC risk, recipient factors, HLA factors, and combination transplant. See table.
Conclusions: A majority of donor hearts are turned down for size mismatch and not quality. These hearts are most likely used by other programs where D/R size matching is appropriate. Further investigation into donors with poor quality should be pursued as some may be viewed acceptable by other programs. A donor/recipient scoring system may be helpful to minimize turned down donor hearts.
Endpoints -- Reasons for Refusal (n=347); Size Mismatch between Donor/Recipient: 36.9% (128/347); Poor Quality: 25.6% (89/347); Duplicate Offer: 11.2% (39/347); Social History/CDC High Risk: 2.9% (10/347); Recipient Factors: 2.3% (8/347); HLA Factors: 7.5% (26/347); Combination Transplant: 2.0% (7/347).
Comments
Presented at: GW Research Days 2016