Abstract
Heart transplantation is an effective mode of treatment for patients suffering from end-stage heart failure but the demand for hearts far outweighs supply. Approximately 10–20% of potential heart-transplant recipients die on the waiting list.1 Despite public education initiatives, activity in heart transplantation has been falling, with activity in the UK dropping from >250 cases/year in 1995 to 174 in 2001–2.2 A specific problem within heart transplantation is the low yield of transplantable hearts from the existing donor pool. Once consent has been obtained, the average utilization rate of donor hearts ranges from 39 to 42%.3 Although the failure to use donor hearts is multifactorial, left ventricular dysfunction is the commonest single cause and is responsible for approximately 26% of the unused organs.4 Brain stem death (BSD) is associated with intensive sympathetic nervous system activity and the release of pathophysiological amounts of catecholamines into the circulation.5 This sympathetic ‘storm’ may provoke both myocardial ischaemia6 and an inflammatory reaction with release of cytokines that can exacerbate organ injury. The storm is characterized by a fluctuating blood pressure due to altered vascular resistance, a variable volume status and abnormalities of myocardial wall motion. Despite differences in the demographics of the patients presenting with brain stem death from different causes (vascular, tumour, trauma, hypoxic or infective), there does not appear to be a difference either in early or late outcome of cardiac transplantation according to donor cause of death. Whether there are different echocardiographic appearances of the donor heart according to cause of brain stem death is not established.7 The best method of assessing the donor heart remains controversial. Currently, selection involves a review of the present and past medical history of the donor, invasive monitoring of donor heart function with central venous and pulmonary artery catheters, …
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
