The Downtime Donor Heart: Analysis of Pre-Transplant Function and Current Utilization for Transplantation

Abstract

Purpose Previous investigation reveals that donors resuscitated following cardiorespiratory arrest can be utilized for cardiac transplantation with satisfactory post-transplant survival within recipients of these organs. We analyzed this donor group to determine its contribution to transplantation and evaluate donor heart function after resuscitation. Methods and Materials We reviewed 225 consecutive donor organs offered to our institution for cardiac transplantation. Demographic and clinical data was obtained from UNOS. Functional data was obtained by analyzing donor echocardiograms. “Downtime” donor hearts (DD) were compared with organs from conventional donors without a period of arrest (CD). Results A history of resuscitation following circulatory arrest was present in 99 donors (44%). The mean downtime was 30 +/- 21 minutes. Organ utilization was 48% in the DD group vs. 45% for CD; p=NS. Donor age was significantly lower in the DD group (41+/-15 vs. 36+/-14;p=0.01), there was no difference in height or weight. Peak troponin I concentration (DD 2.3+/-4.3 vs. CD 1.1 +/-3.6 ng/ml; p=0.04) was elevated in the DD group. Left ventricular ejection fraction was significantly greater in the CD group. (DD 58.6+/-9% vs. CD 61.3+/-8.7%; p=0.02). The percentage of donor hearts with LV dysfunction (LVEF Conclusions Organs procured from donors resuscitated following cardiocirculatory arrest currently contribute a substantial proportion of organs for cardiac transplantation. Cardiac function in these donors is acceptable, albeit marginally impaired in comparison to those without a history of arrest. The potential for recovery and utilization of donor hearts in this setting may further support the prospect of clinical DCD cardiac transplantation.