TY - JOUR
T1 - Maximizing donor allocation
T2 - A review of UNOS region 9 donor heart turn-downs
AU - Mancini, Donna
AU - Goldstein, Daniel
AU - Taylor, Samantha
AU - Chen, Leway
AU - Gass, Alan
AU - DeLair, Samantha
AU - Pinney, Sean
N1 - Funding Information:
Abbreviations: CVA, cerebrovascular accident; ECG, electrocardiogram; ECHO, echocardiography; HCV, hepatitis C virus; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; LVH, left ventricular hypertrophy; NIH, National Institutes of Health; NYCTC, New York Cardiothoracic Transplant Consortium; NYS, New York State; OPO, organ procurement organization; OPTN, Organ Procurement and Transplantation Network; PHS, Public Health Service; SRTR, Scientific Registry of Transplant Recipients; UNOS, United Network for Organ Sharing.
Funding Information:
There are several limitations to this study. A major limitation is inaccuracies regarding donor acceptance and refusal as reported in DonorNet. Data entry for organs was variably complete. Refusal and disposition codes may not accurately reflect the reasons for organ turndowns. The lack of accurate information from DonorNet has resulted in funding of a National Institutes of Health (NIH) trial (NCT02376387; Evidence Based Evaluation and Acceptance of Donor Hearts for Transplantation; P.I. Khush; study start date: March 2015). This prospective study is focused on the standardized collection of data for cardiac donor evaluation to identify clinical correlates of cardiac function in potential donors, to prospectively study reasons for non-acceptance of hearts offered for transplantation, and to develop clinical tools to assist transplant centers with real-time decisions regarding donor heart acceptance. Data will be collected on a cohort of 5,000 donors managed by seven OPOs across the United States over the course of 5 years.
Funding Information:
This study was conducted with funding provided by the New York Cardiothoracic Transplant Consortium and the New York State Department of Health. The opinions, results, findings and/or interpretations of data contained herein are the responsibility of the New York Cardiothoracic Transplant Consortium and do not necessarily represent the opinions, interpretations or policy of the State of New York.
PY - 2017/12
Y1 - 2017/12
N2 - This study was performed to determine if organ selection practices for heart utilization by Region 9 transplant programs were optimal, and to identify opportunities to increase local organ recovery. A retrospective review of de-identified region-wide donor data January 1, 2010 through December 31, 2013 was performed. Over the study period 537 heart donors were identified, of which 321 (60%) were transplanted. Two hundred-sixteen consented hearts were not used; 190 of these were not recovered, and 26 were recovered but not transplanted. Of these, 245/321 (76%) hearts were transplanted at one of 5 regional programs, 15 (5%) were transplanted out of region as primary offers, and 61 (19%) were turned down in region and exported. Of the 61 exported hearts, 43 were turned down in region for donor-related “quality” codes (UNOS 830, 833-837) by at least one program, the remaining 18 hearts were turned down for non-”quality” reasons, primarily histocompatibility and size. Only 5/43 exported were turned down for “quality” reasons by all regional programs offered the organ. A review of consented, not recovered donor offers suggested an additional 28 organs were possibly appropriate for transplant. Our review of regional turn-downs suggests transplant centers could potentially identify additional usable organs without compromising short-term outcomes.
AB - This study was performed to determine if organ selection practices for heart utilization by Region 9 transplant programs were optimal, and to identify opportunities to increase local organ recovery. A retrospective review of de-identified region-wide donor data January 1, 2010 through December 31, 2013 was performed. Over the study period 537 heart donors were identified, of which 321 (60%) were transplanted. Two hundred-sixteen consented hearts were not used; 190 of these were not recovered, and 26 were recovered but not transplanted. Of these, 245/321 (76%) hearts were transplanted at one of 5 regional programs, 15 (5%) were transplanted out of region as primary offers, and 61 (19%) were turned down in region and exported. Of the 61 exported hearts, 43 were turned down in region for donor-related “quality” codes (UNOS 830, 833-837) by at least one program, the remaining 18 hearts were turned down for non-”quality” reasons, primarily histocompatibility and size. Only 5/43 exported were turned down for “quality” reasons by all regional programs offered the organ. A review of consented, not recovered donor offers suggested an additional 28 organs were possibly appropriate for transplant. Our review of regional turn-downs suggests transplant centers could potentially identify additional usable organs without compromising short-term outcomes.
KW - clinical research/practice
KW - donors and donation
KW - heart (allograft) function/dysfunction
KW - heart transplantation/cardiology
KW - organ procurement and allocation
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U2 - 10.1111/ajt.14499
DO - 10.1111/ajt.14499
M3 - Article
C2 - 28898542
AN - SCOPUS:85030550973
VL - 17
SP - 3193
EP - 3198
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 12
ER -