Are non-brain stem-dead cardiac donors acceptable donors?
BACKGROUND
The deleterious effects of brainstem death (BSD) on donor cardiac function and endothelial integrity have been documented previously. Domino cardiac donation (heart of a heart-lung recipient transplanted into another recipient) is a way to avoid the effects of brainstem death and may confer both short- and long-term benefits to allograft recipients.


METHODS
This study evaluates short- and long-term outcome in heart recipients of BSD donors (cadaveric) as compared with domino hearts explanted from patients who underwent heart-lung transplantation.


RESULTS
Patients having undergone cardiac transplantation between April 1989 and August 2001 at Papworth Hospital were included (n = 571). Domino donor hearts were used in 81 (14%) of these cases. The pre-operative transpulmonary gradient was not significantly different between the two groups (p = 0.7). There was no significant difference in 30-day mortality (4.9% for domino vs 8.6% for BSD, p = 0.38) or in actuarial survival (p = 0.72). Ischemic time was significantly longer in the BSD group (p < 0.001). Acute rejection and infection episodes were not significantly different (p = 0.24 vs: 0.08). Relative to the BSD group, the risk (95% confidence interval) of acute rejection in the domino group was 0.89 (0.73 to 1.08). Similarly, the relative risk of infection was 0.78 (0.59 to 1.03). The 5-year actuarial survival rates (95% confidence interval) were 78% (69% to 87%) and 69% (65% to 73%) in the domino and BSD groups respectively. Angiography data at 2 years were available in 50 (62%) and 254 (52%) patients in the domino and BSD groups, respectively. The rates for 2-year freedom from cardiac allograft vasculopathy (CAV) were 96% (91% to 100%) and 93% (90% to 96%), respectively.


CONCLUSIONS
Despite the lack of endothelial cell activation after brainstem death and a shorter ischemic time, the performance of domino donor hearts was similar to that of BSD donor hearts. This may indicate a similar pathology (i.e., endothelial cell activation) in the domino donors.
Luckraz
Heyman
H
Transplant Unit, Papworth Hospital, Papworth Everard, Cambridge, UK.
Charman
Susan C
SC
Parameshwar
Jayan
J
Tsui
Steven S
SS
Dunning
John
J
Wallwork
John
J
Large
Stephen R
SR
D000206:Actuarial Analysis; D000328:Adult; D001926:Brain Death; D001933:Brain Stem; D002102:Cadaver; D016022:Case-Control Studies; D004730:Endothelium, Vascular / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D016027:Heart Transplantation / Q000379:methods; D016041:Heart-Lung Transplantation; D006801:Humans; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome