[Analysis of the criteria that contribute to the decision to harvest the heart in brain-dead organ donors].
OBJECTIVE
The number of cardiac transplantation procedures does not increase because of the lack of donor hearts despite an increase in the number of brain-dead organ donors. The criteria used to select a donor heart are not formally standardized. The aim of the present study was to analyze the criteria that contribute to the selection of a donor heart.


METHODS
Descriptive, retrospective study.


METHODS
Clinical parameters, the initial causes that lead to brain death, maximum doses of catecholamines, several biochemical markers of myocardial ischaemia/necrosis as well as several echocardiography criteria were extracted from a prospectively collected database. Univariate and multivariate (logistic regression) analyses were performed with the "harvested heart" as dependent variable and the above-cited independent variables.


RESULTS
One hundred and eighty consecutive brain-dead patients admitted from 1st October 1998 to 31st December 2000 out of which 112 gave at least one organ were analyzed. Among these 112 patients, 59 (39 males and 20 females) were pre-selected as potential heart donors. Only 44 hearts were harvested. Logistic regression analysis showed that harvesting of the heart was more probable if the donor were a male, had no left ventricle systolic wall motion abnormalities, had low doses of norepinephrine and low serum troponin Ic concentrations.


CONCLUSIONS
After an initial phase of selection, the final decision to harvest a heart is based on several criteria. These results should be an incentive to conceive a score that could allow a more formal decision process for heart harvesting.
Boudaa
C
C
Département d'anesthésie-réanimation chirurgicale, hôpital central, CO no 34, 54035 Nancy, France.
Perrier
J-F
JF
Lalot
J-M
JM
Treuvey
L
L
Voltz
C
C
Strub
P
P
Charpentier
C
C
Audibert
G
G
Meistelman
C
C
Mertes
P-M
PM
Longrois
D
D
D000293:Adolescent; D000328:Adult; D015415:Biomarkers; D001926:Brain Death; D016208:Databases, Factual; D003657:Decision Making; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000502:physiology*; D006334:Heart Function Tests; D016027:Heart Transplantation / Q000502:physiology* / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000628:therapy; D009206:Myocardium / Q000378:metabolism; D009638:Norepinephrine / Q000097:blood; D014336:Troponin / Q000097:blood; D016277:Ventricular Function, Left
D015415:Biomarkers; D014336:Troponin; D009638:Norepinephrine