Elsevier

Transplantation Proceedings

Volume 50, Issue 10, December 2018, Pages 4062-4063
Transplantation Proceedings

Case Report
Thoracic transplantation
Successful Outcome Following Orthotopic Heart Transplantation With a Donor Half Way Across The Country

https://doi.org/10.1016/j.transproceed.2018.09.014Get rights and content

Abstract

Orthotopic heart transplantation is the criterion standard treatment for end-stage heart failure and the number of recipient candidates has been increasing. Despite this increasing demand, there is limited donor organ supply. In order to surmount this challenge, we propose harvesting donor hearts from more distant locations and accepting longer cold ischemic times.

The usual accepted total ischemic time limit for the transplanted human heart is up to 4 hours. Here, we report the successful use of a donor heart from 1268 miles away with a total allograft ischemic time greater than 6 hours.

Section snippets

Case

A 68-year-old man with nonischemic cardiomyopathy was listed for heart transplant. He required multiple hospitalizations despite maximal medical therapy and placement of an implantable cardioverter defibrillator. A brain-dead donor with the same blood type became available, and our patient was selected as the first-priority recipient. The donor was a 57-year-old woman whose heart had an acceptable size match to the recipient (height, +11%; body weight, +50%) and normal biventricular function.

Discussion

Historically, Shumway et al initially obtained a donor heart from an operating room adjacent to the recipient operating room. Over time, the donor distance and ischemic time gradually increased. The advent of University of Wisconsin cold organ preservation solution decreased the amount of ischemic myocardial injury, thereby allowing even longer allograft ischemic time [4]. To date, the acceptable total allograft ischemic time for the transplanted human heart is reported to range up to 4 hours

References (11)

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    However, there still is uncertainty regarding the prognostic effect of CIT and of the cutoff value that might have relevant clinical implications. Some studies have reported no differences in survival even with prolonged CIT [13,14] or have described different cutoffs [15,16]. Our data suggest that we should be concern when ischemic time is longer than 4 h. Del Rizzo et al. also found a clear relation of CIT >4 h with mortality, but only in donors >50 years [17].

  • Relation of Length of Survival After Orthotopic Heart Transplantation to Age of the Donor

    2020, American Journal of Cardiology
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    However, approximately 10% of all candidates on the waiting list for solid-organ transplantation die each year without receiving an organ.3 To surmount the organ shortage challenge, we have previously proposed alternative approaches to maximize organ allocation by utilizing marginally acceptable organs,5,6 harvesting donor hearts from distant locations,7 accepting longer cold ischemic times,8 utilizing obese donor hearts,9 and applying a domino heart transplantation as a uniquely efficacious surgical strategy.10 Although the mean donor age for heart transplant has increased from 31 years old in 1992 to 35 years old in 2013,11 only 3% of donor graft was from advanced-aged donor > 60 years.

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