Capitalizing on Missed Opportunities: An Internal Retrospective Review of Heart Transplant Donor Selection

Abstract

Purpose Given the limited supply and increasing demand, the heart transplant community has been searching for ways to alleviate the donor shortage. The absence of an evidence based universal donor selection criteria naturally leads to many potential donor hearts being discarded. Based on the SRTR database, our heart transplant team has achieved a survival rate exceeding national standards. We reviewed our donor selection process in search for donor characteristics that lead to more organ utilization. Methods A retrospective analysis of 15 orthotopic heart transplant recipients was performed from January 2019 to January 2020. Data obtained from the EMR and the United Network for Organ Sharing. Donor characteristics were collected. All declined organs have a refusal code that is selected by the evaluating center. The definition of these codes is set by Donor Net. Comparisons between reasons for refusal and our institutions reason for acceptance were made. Results We noted that all 15 donors, had the refusal code “830” documented by a center at least once, which means the center declined the potential match due to an incompatibility due to “donor age, hypertension, prolonged hypotension, high vasopressor/ medication dosage, cardiac arrest, evidence of infection/positive cultures, non-heart beating, etiology of death, donor unstable, donor diabetes, other medical history”. This appeared as the predominant refusal code that centers used in 9 donors. Conclusion Many good quality organs are declined for vague medical reasons. This is echoed in the 90-day survival rate of our 15 patients and our long-term program outcomes. Refusal code 830 encompasses an overly broad array of medical reasons to decline an organ. More specific refusal codes that can be linked to specific organ and recipient outcomes can help dictate evidence-based donor selection guidelines. Larger multicenter studies with extended follow-up and linking the rejection codes to outcomes is needed to validate these observations.