Evolution of heart transplant donor characteristics in the 21st century: A United States single center's experience

Abstract

Despite a record setting number of heart transplants performed annually, the national donor shortage continues to plague transplant teams across the United States. Here we describe the barriers to adaptation of numerous "non-traditional" orthotopic heart transplant donor characteristics including donors with hepatitis C virus, those meeting criteria for donation after cardiac death, donors with coronavirus disease 19 infection, donors with the human immunodeficiency virus, and grafts with left ventricular systolic dysfunction. Our center's objective was to increase our transplant volume by expanding our donor pool from "traditional" donors to these "non-traditional" donors. We detail how medical advances such as certain laboratory studies, pharmacologic interventions, and organ care systems have allowed our center to expand the donor pool thereby increasing transplantation volume without adverse effects on outcomes.

Keywords: COVID-19; Donation after cardiac death; Hepatitis C virus; Human immunodeficiency virus; Left ventricular systolic dysfunction; Orthotopic heart transplantation.

Figure 1

Key events that have shaped 21^st century donor characteristics. Despite the changing landscape of donor characteristics, national volume of non-traditional donors remains low. HOPE: HIV Organ Policy Equity; HCV Ab: Hepatitis C virus antibody; HIV: Human immunodeficiency virus; DAA: Direct acting antiviral; NAT: Nucleic acid testing; DCD: Donation after cardiac death; COVID: Coronavirus disease.

Figure 2

Evolving single center donor characteristics during the 21^st century. As of 2022, more than half of the transplants performed were from non-traditional donors. HCV Ab: Hepatitis C virus antibody; NAT: Nucleic acid testing; DCD: Donation after cardiac death; LVSD: Left ventricular systolic dysfunction; HIV: Human immunodeficiency virus; COVID: Coronavirus disease.