Increasing numbers of people in the United States are developing heart failure, which leads to death within five years in approximately half of patients. While heart transplant waiting lists are becoming longer, a new study published in the American Journal of Transplantation reveals a striking decline in the use of available donor hearts for transplantation in many regions.
"We, as a heart transplant community, are using a small fraction of available donor hearts for transplantation, and we have become more conservative over the past 15 to 20 years in terms of donor heart acceptance," says lead author Dr. Kiran Khush, MD, MAS, of the Stanford University School of Medicine. "This finding is troubling in the setting of a national donor heart shortage and an ever-growing number of critically ill patients awaiting heart transplantation."
For their study, Dr. Khush and her colleagues examined national trends in donor heart acceptance for transplantation by analyzing data from the Organ Procurement and Transplantation Network for all potential adult cardiac organ donors between 1995 and 2010. There was a significant decrease in donor heart acceptance from 44 percent in 1995 to 29 percent in 2006, and subsequent increase to 32 percent in 2010. Older donor age, female sex, and medical conditions predicted non-acceptance of hearts from donors. Donor age and medical conditions increased over time, with a concomitant decrease in acceptance of hearts from donors with undesirable characteristics.
The analysis also demonstrated regional variability in donor heart utilization across the United States, showing that some regions have been using a relatively higher proportion of donor hearts than others. This suggests that donor heart acceptance practices are not standardized and indicates a need for clinical guidelines for donor heart acceptance, as well as more intense efforts to increase the use of donor hearts in areas with relatively low utilization rates.
The investigators noted that there is a very high level of scrutiny of transplant centers by government agencies, which may have the unintended consequence of making transplant centers more "risk averse" and therefore less likely to use marginal donor hearts for transplantation.