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Ann Thorac Surg 1986;41:356-362
© 1986 The Society of Thoracic Surgeons
Section of Cardiovascular and Thoracic Surgery, The University of Arizona, Tucson, AZ
* Address reprint requests to Dr. Emery, Department of Surgery, Arizona Health Sciences Center, 1501 N Campbell Ave, Tucson, AZ 85724
From March 1, 1979, to March 1, 1985, the University of Arizona received 223 cardiac donor referrals. Sixty-two were accepted: 15 local, 23 regional (less than 370 km or 200 nautical miles), and 24 distant (370 to 1556 km or 200 to 840 nautical miles). Thirty-eight donor deaths were due to motor vehicle accidents, 10 to gunshot wounds, 6 to cerebral disease, and 8 to other closed-head lesions. The mean time from injury to brain death was 65 ± 5 hours (± standard error of the mean [SEM]) and from brain death to organ donation, 12 ± 3 hours. The mean ischemic time for the donor hearts ranged from 30 to 233 minutes (mean ± SEM, 128 ± 7 minutes). Fifty patients, otherwise acceptable, were refused as cardiac donors because an ABO-compatible recipient was not available.
Two regionally procured hearts failed at operation, 1 because of unrecognized donor sepsis and 1 from a patient on large-dose inotropic support. Although there was no difference in myocardial function, median survival with follow-up through June 30, 1985, of patients receiving locally, regionally, and distantly procured organs was 59 months, 18 months, and 21 months, respectively. Cumulative proportion 1-year survival was 93%, 56%, and 61%, respectively. The 2-year survival was 85% for patients given locally procured hearts, 43% for those with regionally procured hearts, and 38% for those with a heart from a distant donor. Survival curves showed significantly longer survival for locally procured organs than regionally or distantly procured organs (p < 0.05).
Distant procurement of cardiac organs, although expanding the donor pool, is associated with decreased long-term recipient survival, and donor ischemic time appears to be the significant variable. Regionalization of cardiac transplantation programs should increase the frequency of donor usage by providing appropriate recipients for locally obtained donor organs and, at the same time, reduce donor ischemic time.
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