Review articleMaximizing use of organs recovered from the cadaver donor: cardiac recommendations1 : March 28–29, 2001, Crystal City, Va☆,
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.
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This article was originally published in Circulation. Copyright © 2002 American Heart Association, Inc. Reprinted with permission, Lippincott, Williams & Wilkins.
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Conference Co-Chair