title: Reasons for refusing a donor heart for transplantation in Brazil.
abstract: Major advances have been made in heart transplantation, but there is a discrepancy between the number of patients potentially treatable by transplantation and the limited number of viable grafts. The aim of this study was to evaluate the reasons for refusal of donor hearts.
  
  
  
  This was a retrospective analysis of donor data from an organ procurement organization in the state of São Paulo (Brazil) between 2010 and 2012. Fisher's exact test, Student's t-test, and the Mann-Whitney U-test were used in the statistical analysis.
  
  
  
  Only 26 (7.9%) of 328 potential heart donors actually became donors. Most donors were men (18/26, 69.2%), Caucasians (14/26, 53.8%), and had a mean age of 23.5 yr. There were significant associations of use of donor hearts with the variables: brain death after trauma (p = 0.002), history of hypertension (p = 0.001), electrocardiographic changes (p = 0.007), and age (p = 0.001). Older age (n = 101, 33.4%) was the main reason for refusal of donor hearts, followed by poor medical history (n = 44, 14.6%), cardiac arrest of the donor during donor care (n = 25, 8.3%), use of vasopressor drugs (n = 23, 7.6%), and hemodynamic instability (n = 20, 6.6%).
  
  
  
  Age, poor medical history, cardiac arrest, use of vasopressors, and hemodynamic instability were the most prevalent reasons for refusal of donor hearts. Echocardiogram evaluation is a potential intervention to improve heart transplantation conversion in Brazil.
authors.affiliation: Dante Pazzanese Institute of Cardiology, Organ Procurement Organization, São Paulo, Brazil.
authors.forename: André
authors.identifier: 0000-0002-3941-1216
authors.initials: A
authors.lastname: Feldman
authors.affiliation: Dante Pazzanese Institute of Cardiology, Organization of Organs and Tissues, São Paulo, Brazil.
authors.forename: César Augusto Guimarães
authors.initials: CA
authors.lastname: Marcelino
authors.affiliation: Dante Pazzanese Institute of Cardiology, Organ Procurement Organization, São Paulo, Brazil.
authors.forename: Layse
authors.initials: L
authors.lastname: Beneli Prado
authors.affiliation: Dante Pazzanese Institute of Cardiology, Inpatient Wards, São Paulo, Brazil.
authors.forename: Carine Cristiane
authors.initials: CC
authors.lastname: Fusco
authors.affiliation: Dante Pazzanese Institute of Cardiology, Inpatient Ward II, São Paulo, Brazil.
authors.forename: Mara Nogueira
authors.initials: MN
authors.lastname: de Araújo
authors.affiliation: Dante Pazzanese Institute of Cardiology, Division of Nursing, São Paulo, Brazil.
authors.forename: Andrea Cotait
authors.initials: AC
authors.lastname: Ayoub
authors.affiliation: Dante Pazzanese Institute of Cardiology, Medical Transplant Unit, São Paulo, Brazil.
authors.forename: Antônio Flávio Sanchez
authors.initials: AF
authors.lastname: Almeida
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D016027:Heart Transplantation / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012042:Registries; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D016312:Treatment Refusal / Q000523:psychology*; D055815:Young Adult
keywords: donor selection; heart transplantation; tissue and organ procurement