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Heart Transplant Donor Selection: Recent Insights

  • Thoracic Transplantation (J Patel and A Martin Holm, Section Editors)
  • Published:
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Abstract

Purpose of Review

There are several aspects of donor selection for heart transplantation that are particularly challenging. Information about the donor is often limited and relayed through a review of selected chart snippets and tests. The donor heart must work immediately unlike kidney transplantation where delayed function is common and not life-threatening. This review focuses on recent findings in the literature which are distilled for the transplant clinician to be eminently practical to advise teams as they consider which donor factors are important in individual situations.

Recent Findings

Left ventricular dysfunction has many causes and particularly in younger donors may resolve with time. Such donors can be utilized with excellent results. Donor age is still a critically important risk factor for outcome post-transplant though it is additive with other factors such as left ventricular hypertrophy and anticipated ischemic time. Donor size is another important factor and recent work suggests that calculation of predicted heart mass is superior to simple weight, height, and gender in reaching a decision about donor sizing. Recent work suggests that even donors with non-critical coronary lesions (50% or less) may be utilized with similar outcomes, including a similar incidence of progression of vasculopathy. Diabetes appears to be a manageable comorbidity particularly with careful screening. With the increase in drug-related deaths, a recent study looking at more than 23,000 accepted donors found no difference in long-term survival with multiple drugs in the toxicology screen of the donor which may allow increased use of such donors. Finally, we review the details of donation after circulatory determination of death (DCD). Currently, this is confined to certain specialized centers but this is anticipated to become more common worldwide and enhance the number of transplants over time.

Summary

Current evidence is reviewed and summarized to allow the busy transplant clinician to be up to date on the latest information regarding large and smaller important studies in this field. It is hoped that this review helps teams maximize their use of appropriate donors.

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Authors and Affiliations

  1. Advanced Heart Failure and Transplant Program Cleveland Clinic Heart, Vascular and Thoracic Institute, 950 Cleveland Clinic Blvd, Weston, FL, 33331, USA

    David A. Baran

  2. Division of Cardiology and Heart Failure, Transplant - Lutheran Hospital, Fort Wayne, IN, USA

    Asim Mohammed

  3. Division of Cardiology and Heart Failure, Transplant – St. Vincent’s Hospital, Sydney, Australia

    Peter Macdonald

  4. Lutheran Hospital/IN University School of MedicineFort Wayne (IUSM-FW), Fort Wayne, IN, USA

    Hannah Copeland

  5. Heart Transplant And Mechanical Circulatory Support, Division of Cardiovascular and Thoracic Surgery, Lutheran Hospital, 7910 Jefferson Blvd Suite 102, Fort Wayne, IN, 46804, USA

    Hannah Copeland

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  1. David A. Baran
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  4. Hannah Copeland
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Correspondence to Hannah Copeland.

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Conflict of Interest

Dr. Copeland reports receiving consulting fees from Bridge to Life, and her spouse is a paid consultant for Syncardia. Dr. Baran reports consulting fees from Abiomed, Getinge, Livanova, and Abbott. He is on the Steering Committee for CareDx and Procyrion. He is a speaker for Pfizer. None of the authors has conflicts to report.

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Baran, D.A., Mohammed, A., Macdonald, P. et al. Heart Transplant Donor Selection: Recent Insights. Curr Transpl Rep 9, 12–18 (2022). https://doi.org/10.1007/s40472-022-00355-4

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