Extended criteria for cardiac allograft donors: a consensus study.
METHODS
To achieve a consensus regarding extending the current criteria for referring potential cardiac allograft donor, we sent a detailed questionnaire to all heart transplant surgeons in the United Kingdom.


RESULTS
Replies representing the opinion of 16 heart transplant surgeons (88% response rate) suggest that the majority believe that donor age could be extended up to 55 years even in the absence of a coronary angiogram or echocardiogram. Family history of ischemic heart disease, history of hyperlipidemia or smoking, and brain death caused by paracetamole or barbiturates overdose were not considered prohibitive to cardiac allograft donation. Similarly, chest trauma, prolonged mechanical ventilation, pre-referral cardiac arrest or hypotension for any length of time, and nonspecific ST-segment elevation were not considered to be contraindications. By contrast, significant Q waves in a recent electrocardiogram, the presence of hepatitis C antibodies, pulmonary capillary wedge pressure more than 20 mm Hg, and dependency on multiple inotropic support were considered definite exclusion criteria. Donor hormonal resuscitation (T3-cocktail), insertion of a Swan-Ganz catheter, and direct measurement of intracavitary pressure at the time of retrieval were considered unnecessary by more than 80% of respondents. There was no consensus of opinion regarding the use of donors above the age of 55 years, brain death caused by carbon monoxide poisoning, history of diabetes mellitus, alcohol or drug abuse, systemic infections, electrocardiographic evidence of left ventricular hypertrophy, or the maximum dose of inotropic support required to maintain satisfactory hemodynamics.


CONCLUSIONS
The number of potential cardiac allograft donors can be increased by extending the donor age to 55 years. Brain death caused by Paracetamole and barbiturate overdose may not prohibit organ donation.
el Oakley
R M
RM
Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom.
Yonan
N A
NA
Simpson
B M
BM
Deiraniya
A K
AK
D000293:Adolescent; D000328:Adult; D001926:Brain Death; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008020:Life Support Care; D008875:Middle Aged; D009926:Organ Preservation; D012151:Resuscitation; D011795:Surveys and Questionnaires; D014019:Tissue Donors / Q000600:supply & distribution*; D006113:United Kingdom