Review article
Maximizing use of organs recovered from the cadaver donor: cardiac recommendations1 : March 28–29, 2001, Crystal City, Va☆,

https://doi.org/10.1016/S1053-2498(02)00526-0Get rights and content

Abstract

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 ≈6000 to 8000 per year. Because the number of available donor hearts has not increased beyond ≈2500 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 catheterization and hormonal resuscitation are provided. Administrative recommendations such as enhanced communication strategies among transplant centers and organ-procurement organizations, financial incentives for organ recovery, and expansion of donor database fields for research are also described.

Section snippets

Recommendations to improve the yield of donor evaluation

Both UNOS4 and the American College of Cardiology5 have published guidelines regarding the suitability of potential cardiac donors. Individual centers have published more aggressive guidelines, which have permitted their use of marginal donors, defined as organs that fail to meet 1 or more of the traditional criteria for an optimal cardiac donor. Using organs that otherwise would have been discarded, these centers have provided good recipient outcomes.6, 7 The available evidence indicates that

Recommendations for improving donor management

Given that a single echocardiographic assessment may be inaccurate or may fail to predict long-term ventricular contractile function, failure to use a donor heart because of the initial ejection fraction alone is not justified. Hemodynamic and metabolic management should be performed before the organ is declined when donor left ventricular dysfunction is present.

The goals of hemodynamic management are to achieve euvolemia, to adjust vasoconstrictors and vasodilators to maintain a normal

Recommendations to improve organ recovery

Ideally, a set of established criteria for heart suitability would allow for regional evaluation and recovery, which would increase the efficiency of the process. However, changing the current system of recovery will require time and patience given the inherent conservatism related to the mortality of early allograft dysfunction. For this reason, a logical first step would be to attempt regional donor evaluation and management before widespread regional recovery is attempted. However, pilot

Alternate recipient list

The purpose of an alternate recipient list is to match certain recipients, who might be excluded from a standard list because of advanced age or other characteristics, with marginal donor hearts that would otherwise go unused. From 1992 to 2000, the University of California at Los Angeles transplanted 260 donor hearts that were classified as marginal because of abnormalities that included age over 55 years, ejection fraction <50% with inotropes, high-dose inotropes, CAD, mild LVH by

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    ☆

    “Maximizing Use of Organs Recovered From the Cadaver Donor” consensus conference report, March 28 and 29, 2001 Crystal City, Virginia. The conference was conducted with financial and other support from the American Society of Transplantation, the American Society of Transplant Surgeons, and the International Society for Heart and Lung Transplantation.

    1

    This article was originally published in Circulation. Copyright © 2002 American Heart Association, Inc. Reprinted with permission, Lippincott, Williams & Wilkins.

    †

    Conference Co-Chair

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    Copyright © 2002 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.