Can Heart Donation Exclusion Factors Be Overcome?

Abstract

A shortage of heart donors is limiting the expansion of transplant programs. Our aims were to investigate the impact of different heart donation exclusion factors and to examine ways of increasing the donor pool. We carried out a retrospective descriptive study of individuals donating organs at a university hospital over a ten-year period. Males under 50 years of age and females under 55 years were regarded as potential heart donors. We recorded the etiology of brain death, initial heart donation exclusion factors, and later reasons for rejection. We studied 130 organ donors, 69 of whom were regarded as potential heart donors. Thirty-nine actually became heart donors (i.e., 30% of all donors and 56.5% of those of a suitable age). Thirteen were excluded because of a history of heart disease; the majority died from ischemic or hemorrhagic stroke, excluding rupture of an aneurysm or arteriovenous malformation (P< .005). Another 11 donors were excluded because of ventricular dysfunction, which was probably secondary to brain death in 10 patients. Ventricular dysfunction accounted for 30% of cases of heart donation exclusion. A comparison of donor subgroups showed that the incidence of ventricular dysfunction did not vary according to the cause of brain death. Among 27 elderly potential donors, 70% died of stroke and 85% had a diagnosis of, or risk factors for, heart disease. Ventricular dysfunction accounted for 30% of cases of heart donation exclusion. Prevention or reversal of this condition could increase the heart donor pool.