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. 2015 Mar;15(3):642-9.
doi: 10.1111/ajt.13055. Epub 2015 Feb 10.

National decline in donor heart utilization with regional variability: 1995-2010

K K Khush  1 , J G Zaroff, J Nguyen, R Menza, B A Goldstein
Affiliations

National decline in donor heart utilization with regional variability: 1995-2010

K K Khush et al. Am J Transplant. 2015 Mar.

Abstract

The severe shortage of donor hearts limits the availability of transplantation for the growing population of patients with end-stage heart disease. We examined national trends in donor heart acceptance for transplant. OPTN data were analyzed for all potential adult cardiac organ donors between 1995 and 2010. Donor heart disposition was categorized as transplanted, declined for transplant or other. We studied changes in the probability of donor heart acceptance according to demographic and clinical characteristics, nationwide and by UNOS region. Of 82 053 potential donor hearts, 34% were accepted and 48% were declined (18% used for other purposes). There was a significant decrease in donor heart acceptance from 44% in 1995 to 29% in 2006, and subsequent increase to 32% in 2010. Older donor age, female sex and medical co-morbidities predicted non-acceptance. Donor age and co-morbidities increased during the study period, with a concomitant decrease in acceptance of hearts from donors with undesirable characteristics. Overall, predictors of heart non-use were similar across UNOS regions, although utilization varied between regions. Regional variation suggests a potential to improve heart acceptance rates in under-performing regions, and supports research and policy efforts aimed at establishing evidence-based criteria for donor heart evaluation and acceptance for transplantation.

Keywords: Clinical research/practice; Organ Procurement and Transplantation Network (OPTN); donors and donation: donor evalution; heart transplantation/cardiology; organ acceptance; organ procurement and allocation.

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Figures

Figure 1
Figure 1. Proportion of donor hearts accepted or declined for transplantation
This includes all donors after neurologic determination of death (brain dead donors), age 18–70 years, from 1995 to 2010. Dashed lines indicate the following events: (A) 2001: Crystal City recommendations; (B) 2003: Organ Donation Breakthrough Collaborative; (C) 2006: broader regional sharing of donor hearts; (D) 2008: CDC high-risk designation.
Figure 2
Figure 2
(A) Change in the prevalence of donor characteristics that predict heart non-utilization during the study period. (B) Change in the percentage of hearts accepted for transplantation, by donor characteristics. (C) Change in posttransplant recipient 30-day and 1-year survival. CVA, cerebrovascular accident; LVAD, left ventricular assist device.
Figure 3
Figure 3. Percentage of donor hearts accepted for transplantation, by UNOS region
(A) United States map showing geographic location of 11 UNOS regions, (B) 1995–1999, (C) 2000–2005, (D) 2006–2010. (note B–D: Alaska and Hawaii are not shown, but belong to region 6).
Figure 4
Figure 4
Odds ratios for donor heart acceptance for transplantation, by donor characteristics and UNOS region
Figure 5
Figure 5. Changes in the probability of donor heart acceptance over the study period, by UNOS region
(A) Unadjusted and (B) adjusted for donor characteristics that predict non-use.
See this image and copyright information in PMC

References

    1. Lund LH, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth official adult heart transplant report—2013; focus theme: Age. J Heart Lung Transplant. 2013;32:951–964. - PubMed
    1. Colvin-Adams M, Smithy JM, Heubner BM, et al. OPTN/SRTR 2012 Annual Data Report: Heart. Am J Transplant. 2014;14:113–138. - PubMed
    1. Khush KK, Menza R, Nguyen J, Zaroff JG, Goldstein BA. Donor predictors of allograft use and recipient outcomes after heart transplantation. Circ Heart Fail. 2013;6:300–309. - PMC - PubMed
    1. Zaroff JG, Rosengard BR, Armstrong WF, et al. Consensus conference report: Maximizing use of organs recovered from the cadaver donor: Cardiac recommendations. Circulation; VA; Crystal City. 2002. pp. 836–841. March 28–29, 2001. - PubMed
    1. Shafer TJ, Wagner D, Chessare J, Zampiello FA, McBride V, Perdue J. Organ donation breakthrough collaborative: Increasing organ donation through system redesign. Crit Care Nurse. 2006;26:33–42. 44-38; quiz 49. - PubMed

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