The effect of donor ischemic time on mortality in heart transplanted patients (original) (raw)
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The Journal of Heart and Lung Transplantation, 2002
The shortage of available donor hearts continues to limit cardiac transplantation. For this reason, strict criteria have limited the number of patients placed on the US waiting list to Ϸ6000 to 8000 per year. Because the number of available donor hearts has not increased beyond Ϸ2500 per year, the transplant waiting list mortality rate remains substantial. Suboptimal and variable utilization of donor hearts has compounded the problem in the United States. In 1999, the average donor yield from 55 US regions was 39%, ranging from 19% to 62%. This report provides the detailed cardiac recommendations from the conference on "Maximizing Use of Organs Recovered From the Cadaver Donor" held March 28 to 29, 2001, in Crystal City, Va. The specific objective of the report is to provide recommendations to improve the evaluation and successful utilization of potential cardiac donors. The report describes the accuracy of current techniques such as echocardiography in the assessment of donor heart function before recovery and the impact of these data on donor yield. The rationale for and specific details of a donor-management pathway that uses pulmonary artery
European Journal of Cardio-Thoracic Surgery, 2010
Objective: The purpose of this study is to investigate the potential availability of hearts from adult donation after cardiac death (DCD) donors within an acceptable hypoxic period. Methods: We retrospectively reviewed a donor database from the University of Wisconsin Organ Procurement Organization Donor Tracking System between 2004 and 2006. The DCD population (n = 78) was screened using our inclusion criteria for DCD cardiac donor suitability, including warm ischaemic time (WIT) limit of 30 min. In the same period, 70 hearts were donated from brain-dead donors. Results: Of 78 DCD donors, 12 (15%) met our proposed DCD cardiac donor criteria. The mean WIT of these 12 DCD donors was 21 min (range 14-29 min). When inclusion criteria are further narrowed to (1) age <30 years, (2) WIT <20 min and (3) male gender, only two out of 12 met the criteria. Conclusions: Based on our proposed DCD cardiac donor criteria, the potential application of DCD cardiac donors would represent an increase in cardiac donation of 17% (12/70) during the 3-year period. When the criteria were narrowed to the initial 'ideal' case, only two donors met such criteria, suggesting that such 'ideal' DCD donors are rare but they do exist.
The changing profile of the cardiac donor
Journal of Heart and Lung Transplantation, 2001
Background: Expansion of traditional donor criteria has become standard in most centers. To determine how this has affected donor profiles, at our institution, we reviewed all adult (age Ն 16) cardiac donors of the past 15 years.
Assessment of potential heart donors: A statement from the French heart transplant community
Archives of cardiovascular diseases, 2017
Assessment of potential donors is an essential part of heart transplantation. Despite the shortage of donor hearts, donor heart procurement from brain-dead organ donors remains low in France, which may be explained by the increasing proportion of high-risk donors, as well as the mismatch between donor assessment and the transplant team's expectations. Improving donor and donor heart assessment is essential to improve the low utilization rate of available donor hearts without increasing post-transplant recipient mortality. This document provides information to practitioners involved in brain-dead donor management, evaluation and selection, concerning the place of medical history, electrocardiography, cardiac imaging, biomarkers and haemodynamic and arrhythmia assessment in the characterization of potential heart donors.
Life-years gained by reducing donor heart ischemic times
Transplantation, 2009
Transplantation is limited by the number of available donor organs. Donor organ maintenance systems are a recent technological advance. These systems may increase the number of donor organs that can be used and improve outcomes by decreasing donor organ ischemic time (IT). The purpose of this study was to determine the potential life-years gained if IT in the United Kingdom were decreased for cardiac transplantation.
HEART TRANSPLANT: INDICATIONS AND PATIENTS’ QUALITY OF LIFE (Atena Editora)
HEART TRANSPLANT: INDICATIONS AND PATIENTS’ QUALITY OF LIFE (Atena Editora), 2023
Heart failure has been increasing more and more in recent years due to the population's increased longevity, advances in the treatment of acute heart attacks with the use of thrombolytics and angioplasty, the expansion of cardiac interventions and improvements in the diagnosis of the syndrome. With the current modifications incorporated into pharmacological treatment, there has been an improvement in patient survival. Therefore, the evolution of cardiomyopathy to terminal forms is unquestionable due to the characteristics of the disease and, in these situations, transplantation may be the only alternative. Heart transplantation is the only effective way to restore the patient's hemodynamic functions, however it has different limitations and does not apply to all candidates. The limitation of viable organs is one of the biggest factors that impede the development of transplants. This problem becomes more evident when it comes to organs that are more sensitive to shock and ischemia injuries. Despite the great advances made in legislation on organ transplants, there is still a lack of an effective health policy aimed at promoting the recruitment and adequate maintenance of donors so that this situation can be reversed. The quality of donated organs and the serious clinical condition of candidates arriving at transplant centers are the main factors responsible for unsatisfactory results in the immediate phase of heart transplantation. The present study aims to present a review of the indications for heart transplantation and the quality of life of patients.
Heart transplantation in the Netherlands: quo vadis?
Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 2006
Heart transplantation is limited by the lack of donor organs. Twenty years after the start of the Dutch transplant programmes in Rotterdam and Utrecht the situation has even worsened, despite efforts to increase the donor pool. The Dutch situation seems to be worse than in other surrounding countries, and several factors that may influence donor organ availability and organ utilisation are discussed. The indications and contraindications for heart transplantation are presented, which are rather restrictive in order to select optimal recipients for the scarce donor hearts. Detailed data on donor hearts, rejected for transplantation, are shown to give some insight into the difficult process of dealing with marginal donor organs. It is concluded that with the current low numbers of acceptable quality donor hearts, there is no lack of capacity in the two transplanting centres nor is the waiting list limiting the number of transplants. The influence of our current legal system on organ d...