title: Are non-brain stem-dead cardiac donors acceptable donors?
abstract: 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.
authors.affiliation: Transplant Unit, Papworth Hospital, Papworth Everard, Cambridge, UK.
authors.forename: Heyman
authors.initials: H
authors.lastname: Luckraz
authors.forename: Susan C
authors.initials: SC
authors.lastname: Charman
authors.forename: Jayan
authors.initials: J
authors.lastname: Parameshwar
authors.forename: Steven S
authors.initials: SS
authors.lastname: Tsui
authors.forename: John
authors.initials: J
authors.lastname: Dunning
authors.forename: John
authors.initials: J
authors.lastname: Wallwork
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Large
mesh_terms: 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