Early donor management increases the retrieval rate of hearts for transplantation in marginal donors.
OBJECTIVE
Organ donations continue to fall, failing to meet the clinical requirements for heart transplantation. Furthermore, the pathophysiology of brain stem death including hormonal and inflammatory changes may lead to significant donor heart injury. Early donor management may potentially alleviate these changes and therefore increase the number of available hearts for transplantation. We aimed to investigate whether early management of borderline donors can increase the heart retrieval rate.


METHODS
Between September 2011 and February 2013, we performed early donor management of 26 potential heart donors in the intensive care units of the respective donor hospitals. At the time of referral donors were considered as borderline based on high-dose inotrope requirements, history of hypertension and cardiopulmonary resuscitation. Our management protocol included insertion of a pulmonary artery catheter and performance of cardiac output studies, weaning noradrenaline and commencing arginine vasopressin, and administration of tri-iodothyronine, methylprednisolone and insulin. Our primary end-point was donor heart acceptance, depending collectively on the results of cardiac output studies, cardiac contractility and coronary artery patency at the time of retrieval operation.


RESULTS
We retrieved 14 (56%) borderline hearts after donor management (Group A) with a 30-day survival rate of 86%. Twelve (44%) organs were declined due to poor heart function (n=8; 66.7%; P<0.001) and/or palpable coronary artery disease (n=4; 33.3%; P=0.018) (Group B). The mean age of Groups A and B was 42.77 and 47.78 years, respectively (P=0.19). Most of the female donors, i.e. 10 (83%), were declined, and only 4 (27%) were accepted (P=0.005). Majority of patients in both groups (Group A: 71.4%; n=10; and Group B: 66.7%; n=8) were on high-dose noradrenaline (>0.08 μg kg(-1) min(-2)) at the time of donor offer. Group A had a mean cardiac output of 6.29 and 3.09 l/min for Group B (P=0.01). A positive smoking history was present in 28.6% (n=4) and 33.5% (n=4) in Groups A and B, respectively (P=0.793). Cardiopulmonary resuscitation was performed on 3 (21.4%) patients in Group A and 2 (16.7%) in Group B (P=0.759). A history of hypertension was present in 7.1% (n=1) of the Group A and 33.3% (n=4) of the Group B donors.


CONCLUSIONS
In our study, we were able to retrieve more than half of the potential heart donors as a result of early active donor management without impacting on the post-transplant recipient outcome. Early active donor management may assist in increasing the number of heart transplantations, thus warranting further investigation.
North West Regional Heart Centre and Heart and Lung Transplant Unit, University Hospital of South Manchester, Wythenshawe,Manchester, UK.
Razi
R
Abuanzeh
North West Regional Heart Centre and Heart and Lung Transplant Unit, University Hospital of South Manchester, Wythenshawe,Manchester, UK.
Faisal
F
Hashmi
North West Regional Heart Centre and Heart and Lung Transplant Unit, University Hospital of South Manchester, Wythenshawe,Manchester, UK.
Ioannis
I
Dimarakis
North West Regional Heart Centre and Heart and Lung Transplant Unit, University Hospital of South Manchester, Wythenshawe,Manchester, UK.
Noman
N
Khasati
North West Regional Heart Centre and Heart and Lung Transplant Unit, University Hospital of South Manchester, Wythenshawe,Manchester, UK.
Ali
A
Machaal
North West Regional Heart Centre and Heart and Lung Transplant Unit, University Hospital of South Manchester, Wythenshawe,Manchester, UK.
Nizar
N
Yonan
North West Regional Heart Centre and Heart and Lung Transplant Unit, University Hospital of South Manchester, Wythenshawe,Manchester, UK rajamiyer.venkateswaran@uhsm.nhs.uk.
Rajamiyer V
RV
Venkateswaran
D000328:Adult; D005260:Female; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement; D019737:Transplants / Q000502:physiology* / Q000592:standards*; D016896:Treatment Outcome
Donor management; Early donor management; Heart transplantation; Organ donor