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Ann Thorac Surg 1990;50:7-10
© 1990 The Society of Thoracic Surgeons

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Articles

Extension of donor criteria in cardiac transplantation: Surgical risk versus supply-side economics

Divisions of Cardiovascular Surgery, Texas Heart Institute and The University of Texas Health Science Center at Houston, Houston, Texas USA

^_* Address reprint requests to Dr Sweeney, University of Texas Medical School, 6431 Fannin, MSB 1.220, Houston, TX 77030.

To combat the continuing shortage of ideal donor hearts, we have used cardiac allografts from high-risk donors for critically ill recipients. We defined high-risk donor variables as age greater than 40 years, systemic (noncardiac) infection, cardiopulmonary resuscitation greater than 3 minutes, ischemic time longer than 5 hours, weight more than 20% less than that of the recipient, and requirements for high doses of inotropes. Of the 305 donors we have used, 73 (23.9%) have been high-risk, with [equation] (80.8%) exhibiting one variable, [equation] (16.4%) exhibiting two variables, and [equation] (2.7%) exhibiting three variables. No correlation was found between the number of donor variables and a poor postoperative result. No infectious complications occurred in 17 patients receiving hearts from potentially infected donors. Hospital mortality rates (30 day) for recipients of high-risk donor versus non-high-risk donor hearts were 8.2% and 6.9%, respectively (not significant). The 1-, 6-, and 12-month actuarial survival rates were 91.7%, 81.2%, and 75.9% for the high-risk donor group and 93.5%, 80.3%, and 77.8% for the non-high-risk donor group (not significant). Among survivors with high-risk donor hearts, mean left ventricular ejection fractions were 0.54 ± 0.08 at 3 months, 0.55 ± 0.08 at 1 year, and 0.54 ± 0.09 at 2 years after transplantation. These results suggest that accepting less than ideal donor hearts can be safe and might be considered when better options are not available.

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