Extended donor criteria for heart transplantation

Abstract

The shortage of ideal donor hearts had led to an increasing number of would-be heart transplant recipients who die while on the waiting list. Therefore analogous to kidney and liver transplantation, an extension of the classical donor criteria became necessary, especially for high-urgency recipients. In a series of 121 orthotopic heart transplantations in 117 patients with a 1-year survival of 77%, the criteria for the selection of donor hearts have been gradually extended. Hearts from donors over 40 years of age but not exceeding 50 years were accepted without coronary angiography for 25 patients. There was no immediate graft failure, and the mean postoperative left ventricular ejection fraction, as assessed by radionuclide ventriculography, was normal. The incidence of late postoperative graft atherosclerosis was slightly but not significantly higher. Donor hearts with severe chest trauma, including bilateral hemothorax, rib fractures, and aortic hematoma were accepted for 11 patients. Immediate graft function was normal in all organs. In seven donors the body weight difference was more than 20%. Three patients with smaller grafts with more than 30% body weight difference had a highly complicated postoperative condition. In one patient acute graft failure was reversible with the administration of high dosages of catecholamines. In the other two patients, however, retransplantation was required because of irreversible failure. Episodes of hypotension that did not exceed 30 minutes had no substantial influence on postoperative graft function. The 1-year survival of recipients with donor grafts not complying with standard criteria was not significantly worse than the survival of patients whose grafts were selected according to the standard (76% versus 79%).(ABSTRACT TRUNCATED AT 250 WORDS)