Expedited Placement of Donor Hearts Increases Morbidity and Mortality Among Bypassed Potential Recipients – A Single Center Experience
1Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
2Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX.
Meeting: 2015 American Transplant Congress
Abstract number: C173
Keywords: Allocation, Heart
Session Information
Session Name: Poster Session C: "Loss of Breath": VADs and Other Pre-Heart Transplant Matters
Session Type: Poster Session
Date: Monday, May 4, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Introduction: Organ procurement organizations (OPOs) may bypass potential recipients for expedited placement of donor organs. OPOs must provide justification for placing an organ outside the match run sequence. These cases are subsequently reviewed and adjudicated by UNOS. The frequency and impact of this allocation mechanism on outcomes of bypassed heart transplant candidates are not well known. We hypothesized that bypassed candidates experience significant morbidity and mortality. We investigated this hypothesis by reviewing our heart organ offer and bypassed candidate reports.
Methods: Heart organ offer reports from 1/1/2012 to 11/30/2014 for our Heart Transplantation Program were reviewed to identify potential primary offers. Bypassed candidates were identified by using the Verify Organ Offer Report within the Manage Data tab in DonorNet. Candidates that were bypassed due to need for a prospective crossmatch, unacceptable antigens, or multi-organ transplants were excluded. For 2014, the match run for each donor was reviewed to identify the number of bypassed candidates and the accepting centers candidate data (when applicable).
Results: The frequency of bypassed candidates expressed as percent of potential primary offers has increased in 2014 (39.7%) compared to 2012 (13.3%) and 2013 (9.2%) (p<.001). To date in 2014, we have identified 30 cases where one or more of our heart transplant candidates have been bypassed. Among bypassed candidates from our center, 5 have died and several candidates either required an LVAD or had their elective 30-day LVAD time expire. The mean number of bypassed candidates from all centers was 295±38 (Range 16-670). The average match sequence number of the accepting center was 532±55 (Range 41-1042). Listing status of the accepting center included 3 Status 1A, 10 Status 1B, and 8 Status 2 candidates. 9 organs were not placed.
Conclusion: Bypassing of heart transplant candidates seems to be occurring at increasing frequency. Accepting centers frequently transplant lower priority candidates. Based on our experience and the mean number of bypassed candidates, it is quite likely that many of these out of sequence allocations are associated with one or more deaths among bypassed, higher priority candidates.
To cite this abstract in AMA style:
Peltz M, Drazner M, Jessen M. Expedited Placement of Donor Hearts Increases Morbidity and Mortality Among Bypassed Potential Recipients – A Single Center Experience [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/expedited-placement-of-donor-hearts-increases-morbidity-and-mortality-among-bypassed-potential-recipients-a-single-center-experience/. Accessed May 18, 2025.« Back to 2015 American Transplant Congress