To Accept or Not Accept, That Is the Question: Donor Heart Selection Process and Outcome of Discarded Organs Transplanted in Another Center.

A. Aliabadi-Zuckermann,¹ J. Goekler,¹ A. Kaider,² J. Riebandt,¹ R. Moayedifar,¹ E. Osorio,¹ T. Haberl,¹ G. Laufer,¹ J. Smits,³ A. Zuckermann.¹

¹Cardiac Surgery, Medical University of Vienna, Vienna, Austria
²Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
³Eurotransplant Foundation, Leiden, Netherlands

Meeting: 2017 American Transplant Congress

Abstract number: 33

Keywords: Heart, Outcome

Session Information

Session Name: Concurrent Session: Heart Waitlist and Allocation: Working to Get It Right

Session Type: Concurrent Session

Date: Sunday, April 30, 2017

Session Time: 2:30pm-4:00pm

Presentation Time: 2:30pm-2:42pm

Location: E267

Purpose: The decision making process to accept a donor heart is very complicated, subjective and less associated with evidence based decisions. In this analysis we evaluated donor heart acceptance, reasons for rejection, alternative center acceptance and outcome over a 15 year period in a big center

MethodsAll donor heart offers reported to our center from 2001 to 2015 [N=2205] were analysed. Heart acceptance (Ac) rate and transplantation rate were calculated. Reasons for non-acceptance were divided into quality (Qu) and non-quality (nQ) reasons. Rejected Donor hearts, accepted in other centers were analysed for transplant rate and outcome (1 year & 3year survival and compared with transplant outcomes in our center.

Results: A total of 699 (31,7%) donor hearts were accepted. Of these 124 (17,7%) were rejected at time of procurement. Main causes were CAD (37%), impaired LVEF (21%), hemodynamic instability (16%), other (26%). Of those 1506 hearts not accepted primarily, 869 (39,4%) were rejected du to quality reasons (Qu: age: 20%, hypertrophy 14%, impaired LVEF 12%, hemodynamic instability 14%, virology 11%, other 20%) and 637 (28,9%) due to non-quality reasons (nQ: mismatch: 71%, capacity 14%, other 15%). 231 (26,6%) of Qu and 346 (54,3%) of nQ hearts were accepted in other centers and of these 170 (73,6%) and 303 (87,6%) were transplanted. One and three year survival post transplantation was significant different between Ac, Qu and nQ respectively (1 year: Ac: 83,7% vs. Qu: 73,5% vs nQ: 81,1%; p=0.011; 3 Year: Ac: 79,1% vs. Qu: 64,9% vs nQ: 75,8%; p<0.0001).

Conclusions: Donor hearts not accepted in our center that were transplanted in another center were associated with a higher mortality if rejected for quality reasons, whereas heart discarded for non quality reasons had similar outcome. There is a strong need for better understanding on donor heart selection.

CITATION INFORMATION: Aliabadi-Zuckermann A, Goekler J, Kaider A, Riebandt J, Moayedifar R, Osorio E, Haberl T, Laufer G, Smits J, Zuckermann A. To Accept or Not Accept, That Is the Question: Donor Heart Selection Process and Outcome of Discarded Organs Transplanted in Another Center. Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Aliabadi-Zuckermann A, Goekler J, Kaider A, Riebandt J, Moayedifar R, Osorio E, Haberl T, Laufer G, Smits J, Zuckermann A. To Accept or Not Accept, That Is the Question: Donor Heart Selection Process and Outcome of Discarded Organs Transplanted in Another Center. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/to-accept-or-not-accept-that-is-the-question-donor-heart-selection-process-and-outcome-of-discarded-organs-transplanted-in-another-center/. Accessed November 22, 2024.

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