title: Donor scoring system for heart transplantation and the impact on patient survival.
abstract: BACKGROUND
  The aim of this study was to design and validate a heart donor score that reflects experts' perceived risk of allograft failure.
  
  
  METHODS
  All heart donors reported to Eurotransplant between January 1, 2005 and December 31, 2008 (N = 4,110) were used to create a donor score. Based on observed discard rates and using multivariate regression, points were assigned for the following donor factors: age; cause of death; body mass index (BMI); diabetes mellitus (DM); duration of ICU stay; compromised history (drug, abuse, sepsis, meningitis, malignancy, HBsAg(+) or anti-HCV(+)); hypertension; cardiac arrest; echocardiography; coronary angiogram; serum sodium; and noradrenaline and dopamine/dobutamine doses. The donor score was obtained by adding all points. All heart donors reported to Eurotransplant in 2009 were included to validate the score (N = 885).
  
  
  RESULTS
  All donor factors, except BMI, DM and duration of ICU stay, significantly predicted discard. Based on the median value of the score, donors were classified into low-risk donors (LRDs: ≤16 points) and high-risk donors (HRDs: ≥17 points). In the validation set, discard rates were significantly different when comparing HRDs (35%) and LRDs (7%) (p < 0.0001). In addition, the heart donor score was significantly associated with 3-year survival: LRD 81.5% vs HRD 70.0% (p = 0.004).
  
  
  CONCLUSIONS
  The heart donor score accurately reflects the likelihood of organ acceptance and predicts long-term patient mortality. Application of this score at time of donor reporting may facilitate donor risk assessment and allow for more appropriate matching of extended criteria donor hearts.
authors.affiliation: Eurotransplant International Foundation Leiden, Leiden, The Netherlands. jsmits@eurotransplant.org
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Smits
authors.forename: Michel
authors.initials: M
authors.lastname: De Pauw
authors.forename: Erwin
authors.initials: E
authors.lastname: de Vries
authors.forename: Axel
authors.initials: A
authors.lastname: Rahmel
authors.forename: Bruno
authors.initials: B
authors.lastname: Meiser
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
authors.forename: Andreas
authors.initials: A
authors.lastname: Zuckermann
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D005060:Europe; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000401:mortality*; D016027:Heart Transplantation / Q000379:methods* / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000592:standards*; D016896:Treatment Outcome