title: Systematic donor selection review process improves cardiac transplant volumes and outcomes.
abstract: BACKGROUND
  Heart transplant remains the definitive therapy for advanced heart failure patients but is limited by organ availability. We identified a large number of donor hearts from our organ procurement organization (OPO) being exported to other regions.
  
  
  METHODS
  We engaged a multidisciplinary team including transplant surgeons, cardiologists, and our OPO colleagues to identify opportunities to improve our center-specific organ utilization rate. We performed a retrospective analysis of donor offers before and after institution of a novel review process.
  
  
  RESULTS
  Each donor offer made to our program was reviewed on a monthly basis from July 2013 to June 2014 and compared with the previous year. This review process resulted in a transplant utilization rate of 28% for period 1 versus 49% for period 2 (P = .007). Limiting the analysis to offers from our local OPO changed our utilization rate from 46% to 75% (P = .02). Transplant volume increased from 22 to 35 between the 2 study periods. Thirty-day and 1-year mortality were unchanged over the 2 periods. A total of 58 hearts were refused by our center and transplanted at other centers. During period 1, the 30-day and 1-year survival rates for recipients of those organs were 98% and 90%, respectively, comparable with our historical survival data.
  
  
  CONCLUSIONS
  The simple process of systematically reviewing donor turndown events as a group tended to reduce variability, increase confidence in expanded criteria for donors, and resulted in improved donor organ utilization and transplant volumes.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Wash. Electronic address: jwsmith@uw.edu.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Smith
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Wash.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: O'Brien
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Wash.
authors.forename: Todd
authors.initials: T
authors.lastname: Dardas
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Wash.
authors.forename: Jay D
authors.initials: JD
authors.lastname: Pal
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Wash.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Fishbein
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Wash.
authors.forename: Wayne C
authors.initials: WC
authors.lastname: Levy
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Wash.
authors.forename: Claudius
authors.initials: C
authors.lastname: Mahr
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Wash.
authors.forename: Sofia C
authors.initials: SC
authors.lastname: Masri
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Wash.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Cheng
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Wash.
authors.forename: April
authors.initials: A
authors.lastname: Stempien-Otero
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Wash.
authors.forename: Nahush A
authors.initials: NA
authors.lastname: Mokadam
mesh_terms: D000328:Adult; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D010348:Patient Care Team; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014861:Washington
keywords: cardiac donor selection; heart transplant; organ utilization; transplant stewardship