title: Temporal trends in heart transplantation from high-risk donors: are there lessons to be learned? A multi-institutional analysis.
abstract: BACKGROUND
  In 2003 the Department of Health and Human Services sponsored the Organ Donation Breakthrough Collaborative (ODBC) with the aim to increase organ donation. After the ODBC, increases in the number of all solid organs transplanted, except for heart, were seen. The aim of this study was to determine if ODBC resulted in temporal changes in the use of hearts from high-risk donors.
  
  
  METHODS
  We analyzed data from the Cardiac Transplant Research Database in three eras: 1990-1995, 1996-2002, and 2003-2007. We explored temporal changes in high-risk donor characteristics: age, gender, hypertension, diabetes mellitus, abnormal echocardiogram, and ischemic time.
  
  
  RESULTS
  Between 1990 and 2007, 7,220 patients underwent transplantation in 26 centers. Donors in the first era were least likely to have high-risk characteristics of higher age (mean, 30 years), female gender (30%), hypertension (8%), diabetes mellitus (1%), structural abnormalities on echocardiogram (7%), and prolonged graft ischemic time (mean, 163 minutes). In the second era, there was a significant increase in the use of donors with the above mentioned high-risk characteristics-32 years, 33%, 10%, 3%, 8% and 181 minutes, respectively. In the third post-ODBC era, no further increase was seen in high-risk donors, but rather a trend for avoidance of risk-32 years, 28%, 10%, 2%, 5% and 186 minutes, respectively.
  
  
  CONCLUSIONS
  Significant temporal changes in the characteristics of heart donors have occurred in the past 17 years. Recent temporal changes, however, cannot be directly attributed to the ODBC efforts.
authors.affiliation: Department of Cardiology, University of Utah Health Science Center, U.T.A.H. Cardiac Transplant Program, Salt Lake City, UT 84132, USA.
authors.forename: Jose N
authors.initials: JN
authors.lastname: Nativi
authors.forename: Robert N
authors.initials: RN
authors.lastname: Brown
authors.forename: David O
authors.initials: DO
authors.lastname: Taylor
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
authors.forename: James K
authors.initials: JK
authors.lastname: Kirklin
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
mesh_terms: D000367:Age Factors; D048909:Diabetes Complications / Q000150:complications; D004452:Echocardiography; D006084:Graft Rejection / Q000453:epidemiology*; D016027:Heart Transplantation / Q000639:trends*; D006801:Humans; D006973:Hypertension / Q000150:complications; D012307:Risk Factors; D012737:Sex Factors; D014019:Tissue Donors; D014481:United States