Great variability in donor heart acceptance practices across the United States

• Published in: American journal of transplantation Vol. 20; no. 6; pp. 1582 - 1596
• Main Authors: Khush, Kiran K., Ball, Robyn L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.06.2020
• Subjects: Blood & organ donations; clinical research/practice; donors and donation; Heart Transplantation; heart transplantation/cardiology; Heart transplants; Humans; Mortality; organ acceptance; organ procurement and allocation; Tissue and Organ Procurement; Tissue Donors; Transplant Recipients; United States; Waiting Lists; United States; United States > US; organ acceptance; heart transplantation/cardiology; clinical research/practice; organ procurement and allocation; donors and donation
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/ajt.15760

Disparities in organ acceptance practices exacerbate donor heart nonuse and lead to increased waiting times and mortality for heart transplant candidates. We studied disparities in donor heart acceptance among US transplant centers and their relations to posttransplant outcomes. Candidate, potential transplant recipient match run, and deceased donor data were obtained from the United Network for Organ Sharing. We analyzed donor, candidate, and transplant center characteristics with respect to organ acceptance, offer acceptance, number of offers before acceptance (organ sequence number), and association with posttransplant mortality. A total of 693 420 donor heart offers made between April 2007 and December 2015 were included. We identified great variability in donor heart acceptance practices among US heart transplant centers. We identified donor and recipient characteristics that were strongly associated with heart organ and offer acceptance, and organ sequence number, and identified inconsistencies among centers with respect to how these characteristics influenced acceptance decisions. Finally, we identified characteristics that were highly predictive of donor heart nonuse and were not associated with increased recipient mortality, which may guide future efforts aimed at increasing use of available hearts for transplantation. In an analysis of 693,420 donor heart offers made in the United States between April 2007 and December 2015, the authors demonstrate great variability in donor heart acceptance practices among transplant centers and identify key opportunities to expand current donor heart utilization. Morris and Vega provide commentary on page 1477.