Standard criteria for an acceptable donor heart are restricting heart transplantation.
BACKGROUND
The lack of satisfactory donor organs limits heart transplantation. The purpose of this study was to determine whether the criteria for suitability of donors may be safely expanded.


METHODS
One hundred ninety-six heart transplantations were performed on 192 patients at our institution from January 1992 to 1995 and were divided into two groups. Group A donors (n = 113) conformed to the standard criteria. Group B donors (n = 83) deviated by at least one factor and consisted of the following: 16 hearts from donors greater than 50 years of age, 33 with myocardial dysfunction (echocardiographic ejection fraction = 0.35 +/- 0.10, dopamine level exceeding 20 micrograms.kg-1.min-1, and resuscitation with triiodothyronine), 33 undersized donors with donor to recipient weight ratios of 0.45 +/- 0.04, 48 with extended ischemic times of 297.4 +/- 53.6 minutes, 25 with positive blood cultures, 16 with positive hepatitis C antibody titers, and 7 with conduction abnormalities (Wolff-Parkinson-White syndrome, prolonged QT interval, bifascicular block).


RESULTS
Thirty-day mortality was 6.2% (7/113) in group A and 6.0% (5/83) in group B. Mortality in group A was attributed to 3 patients with myocardial dysfunction, 2 with infection, 1 with acute rejection, and 1 with pancreatitis; group B had 2 with myocardial dysfunction, 1 with infection, 1 with aspiration, and 1 with bowel infarction. At 12 months, survival and hemodynamic indices were similar between the groups. Of the 16 recipients with hepatitis C-positive hearts, 5 have become hepatitis C positive with mild hepatitis (follow up, 6 to 30 months).


CONCLUSIONS
Expanding the criteria for suitability of donor hearts dramatically increases the number of transplantations without compromising recipient outcome.
Section of Cardiothoracic Surgery, Temple University Health Sciences Center, Philadelphia, Pennsylvania, USA.
V
V
Jeevanandam
S
S
Furukawa
T W
TW
Prendergast
B A
BA
Todd
H J
HJ
Eisen
J B
JB
McClurken
D000328:Adult; D000367:Age Factors; D000368:Aged; D001824:Body Constitution; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome