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Hyun J, Lee SE, Kim JJ. Management of potential cardiac donors. CLINICAL TRANSPLANTATION AND RESEARCH 2024; 38:37-45. [PMID: 38725181 PMCID: PMC11075817 DOI: 10.4285/ctr.23.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 05/14/2024]
Abstract
Heart transplantation (HTx) outcomes have improved with careful donor selection and management; nonetheless, donor shortages remain a major challenge. Optimizing donor management is crucial for improving donor utility rates and post-HTx outcomes. Brain death leads to various pathophysiological changes that can affect multiple organs, including the heart. Understanding these alterations and corresponding management strategies is key to optimizing the donor organ condition. This review assesses several aspects of these pathophysiological changes, including hemodynamic and endocrinological considerations, and emphasizes special consideration for potential cardiac donors, including serial echocardiographic evaluations for reversible cardiac dysfunction and coronary assessments for donors with risk factors.
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Affiliation(s)
- Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Eun Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Copeland H, Knezevic I, Baran DA, Rao V, Pham M, Gustafsson F, Pinney S, Lima B, Masetti M, Ciarka A, Rajagopalan N, Torres A, Hsich E, Patel JK, Goldraich LA, Colvin M, Segovia J, Ross H, Ginwalla M, Sharif-Kashani B, Farr MA, Potena L, Kobashigawa J, Crespo-Leiro MG, Altman N, Wagner F, Cook J, Stosor V, Grossi PA, Khush K, Yagdi T, Restaino S, Tsui S, Absi D, Sokos G, Zuckermann A, Wayda B, Felius J, Hall SA. Donor heart selection: Evidence-based guidelines for providers. J Heart Lung Transplant 2023; 42:7-29. [PMID: 36357275 PMCID: PMC10284152 DOI: 10.1016/j.healun.2022.08.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023] Open
Abstract
The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.
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Affiliation(s)
- Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery Lutheran Hospital, Fort Wayne, Indiana; Indiana University School of Medicine-Fort Wayne, Fort Wayne, Indiana.
| | - Ivan Knezevic
- Transplantation Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David A Baran
- Department of Medicine, Division of Cardiology, Sentara Heart Hospital, Norfolk, Virginia
| | - Vivek Rao
- Peter Munk Cardiac Centre Toronto General Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael Pham
- Sutter Health California Pacific Medical Center, San Francisco, California
| | - Finn Gustafsson
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sean Pinney
- University of Chicago Medicine, Chicago, Illinois
| | - Brian Lima
- Medical City Heart Hospital, Dallas, Texas
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Civilisation Diseases and Regenerative Medicine, University of Information Technology and Management, Rzeszow, Poland
| | | | - Adriana Torres
- Los Cobos Medical Center, Universidad El Bosque, Bogota, Colombia
| | | | | | | | | | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Heather Ross
- University of Toronto, Toronto, Ontario, Canada; Sutter Health California Pacific Medical Center, San Francisco, California
| | - Mahazarin Ginwalla
- Cardiovascular Division, Palo Alto Medical Foundation/Sutter Health, Burlingame, California
| | - Babak Sharif-Kashani
- Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MaryJane A Farr
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luciano Potena
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | | | | | | | | | | | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kiran Khush
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Susan Restaino
- Division of Cardiology Columbia University, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Steven Tsui
- Department of Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniel Absi
- Department of Cardiothoracic and Transplant Surgery, University Hospital Favaloro Foundation, Buenos Aires, Argentina
| | - George Sokos
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Brian Wayda
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Joost Felius
- Baylor Scott & White Research Institute, Dallas, Texas; Texas A&M University Health Science Center, Dallas, Texas
| | - Shelley A Hall
- Texas A&M University Health Science Center, Dallas, Texas; Division of Transplant Cardiology, Mechanical Circulatory Support and Advanced Heart Failure, Baylor University Medical Center, Dallas, Texas
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Baran DA, Mohammed A, Macdonald P, Copeland H. Heart Transplant Donor Selection: Recent Insights. CURRENT TRANSPLANTATION REPORTS 2022. [DOI: 10.1007/s40472-022-00355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chernyavskiy AM, Doronin DV, Fomichev AV, Osipov DE, Shmyrev VA, Karaskov AM. 10-YEAR HEART TRANSPLANTATION EXPERIENCE IN NOVOSIBIRSK. RUSSIAN JOURNAL OF TRANSPLANTOLOGY AND ARTIFICIAL ORGANS 2018. [DOI: 10.15825/1995-1191-2018-1-23-31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aim:to show the analysis of 10-year heart transplantation experience, the main complications and problems of the heart transplantation evaluation. Materials and methods.66 orthotopic heart transplantations were performed in patients with terminal chronic heart failure in our clinic since 2008. The heart failure causes were dilated cardiomyopathy in 46 cases (70%), postinfarction cardiosclerosis in 20 cases (30%). The recipients were 59 men (89%) and 7 women (11%), the average age was 46 ± 10 years. All patients had a severe left heart dilatation and critical left ventricular systolic dysfunction (left ventricular EDV 283 ± 58 ml, left ventricular ejection fraction 17 ± 5%, cardiac index 1.5 ± 0.3 l/min/m2). In some recipients, heart transplantation is performed in the second stage after preliminary implantation of mechanical circulatory support systems (LVAD, BVAD). The fi rst heart transplantations were performed using the biatrial technique (8 cases (12%)), the others were performed using the bicaval technique (58 cases (88%)). After the operation, patients received a three-component immunosuppressive therapy: the inhibitors of calcineurin, mycophenolate and corticosteroids.Results.54 patients (82%) were discharged from the clinic after heart transplantation. The hospital mortality was 12 recipients (18%). The mortality in the long-term period was 10 recipients (15%). The hospital mortality cases were acute graft dysfunction in 5 cases (42%), infectious-septic complications in 4 cases (33%), massive intraoperative bleeding in 2 cases (17%), and total thrombosis of pulmonary artery in 1 case (8%). The death causes in the long-term period were acute transplant rejection in 4 cases (40%), coronary artery disease of the transplanted heart in 3 cases (30%), Kaposi’s sarcoma in 1 case (10%), lung cancer in 1 case (10%), and viral pneumonia in 1 case (10%).Conclusion.Over a 10-year period, we have gained a lot of experience in heart transplantation; the procedures complications have been studied; the stages of preservation, harvesting and transportation of the donor heart, operative technique and postoperative treatment of patients have been improved to avoid complications in the early and long-term postoperative period.
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Affiliation(s)
- A. M. Chernyavskiy
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation
| | - D. V. Doronin
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation
| | - A. V. Fomichev
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation
| | - D. E. Osipov
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation
| | - V. A. Shmyrev
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation
| | - A. M. Karaskov
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation
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The echocardiographic risk assessment of donor hearts for consideration of transplantation. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2017.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Impact of cardiac arrest resuscitated donors on heart transplant recipients' outcome. J Thorac Cardiovasc Surg 2017; 153:622-630. [DOI: 10.1016/j.jtcvs.2016.10.079] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 10/16/2016] [Accepted: 10/20/2016] [Indexed: 11/23/2022]
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Palac RT, Sumner G, Laird R, O'Rourke DJ. Reversible Myocardial Dysfunction after Traumatic Brain Injury: Mechanisms and Implications for Heart Transplantation. Prog Transplant 2016; 13:42-6. [PMID: 12688649 DOI: 10.1177/152692480301300109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reversible myocardial dysfunction is known to occur in patients with cerebrovascular accidents and brain death. Several mechanisms for transient myocardial dysfunction have been proposed, including increased sympathetic activity, hormone depletion, and a reduction in coronary perfusion pressure. The relative importance of each of these mechanisms remains controversial. We report the case of a 19-year-old man who suffered traumatic brain death associated with reversible myocardial dysfunction despite elevated cardiac enzymes. Myocardial recovery occurred after correcting his hemodynamic instability and hypothermia emphasizing the importance of normalization of coronary perfusion pressure and core body temperature. The mechanisms for reversible myocardial dysfunction and their implications for heart transplantation following traumatic brain death are reviewed. A diagnostic strategy is proposed that would allow early recognition of reversible myocardial dysfunction in brain-dead patients.
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Arab D, Yahia AM, Qureshi AI. Cardiovascular Manifestations of Acute Intracranial Lesions: Pathophysiology, Manifestations, and Treatment. J Intensive Care Med 2016; 18:119-29. [PMID: 14984630 DOI: 10.1177/0885066603251202] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this article was to review the effects of acute intracranial lesions on myocardial function. The authors reviewed scientific and clinical literature retrieved from a computerized MEDLINE search from January 1965 through January 2002. Pertinent literature was referenced, including clinical and laboratory investigations, to demonstrate the effects of acute intracranial lesions on the cardiovascular system. The literature was reviewed to summarize the mechanisms of cardiac damage and clinical manifestations and treatment of cardiovascular dysfunction caused by acute intracranial lesions. Myocardial damage and rhythm disturbances were shown to occur with acute intracranial neurological disease. The subgroup of patients used in this study formed a substantial pool of cardiac donors for cardiac transplantation. The pathophysiology of myocardial dysfunction and the optimal management continues to be a source of debate. In this article, the authors will review the anatomy, the available evidence of the pathophysiology, and the management of this complex group of patients. They will also discuss areas that need to be further investigated. Cardiovascular effects of acute intracranial lesions are common and contribute to increased morbidity and mortality.
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Affiliation(s)
- Dinesh Arab
- Department of Medicine, Division of Cardiology, Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo 14209-1194, USA
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Nair N, Gongora E. Role of cardiovascular imaging in selection of donor hearts. World J Transplant 2015; 5:348-353. [PMID: 26722663 PMCID: PMC4689946 DOI: 10.5500/wjt.v5.i4.348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/02/2015] [Accepted: 10/13/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To perform a systematic review of literature on use of cardiovascular imaging in assessment of donor hearts.
METHODS: A systematic search of current literature from January 1965 to August 2015 was performed using PubMed and Google Scholar to investigate the different imaging modalities used to assess donor hearts.
RESULTS: Recent literature still estimates only a 32% utilization of available donor hearts in the United States. Most common imaging modality used is transthoracic echocardiography. Use of advanced imaging modalities such as 3D echocardiography, cardiac computer tomography and cardiac magnetic resonance to evaluate donor hearts is not reported in literature. This review attempts to highlight the relevant imaging modalities that can be used to assess cardiac function in a time-efficient manner. The algorithm suggested in this review would hopefully pave the way to standardized protocols that can be adopted by organ procuring organizations to increase the donor pool.
CONCLUSION: Use of advanced imaging techniques for a thorough assessment of organs will likely increase the donor pool.
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Madias JE. Heart donors and Takotsubo syndrome: an apology: Heart donors and Takotsubo syndrome. Int J Cardiol 2015; 187:541. [PMID: 25863297 DOI: 10.1016/j.ijcard.2015.03.403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 03/28/2015] [Indexed: 11/19/2022]
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, USA.
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11
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“Neurogenic stress cardiomyopathy in heart donors” is a form of Takotsubo syndrome. Int J Cardiol 2015; 184:612-613. [DOI: 10.1016/j.ijcard.2015.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/02/2015] [Indexed: 11/23/2022]
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Kilic A, Emani S, Sai-Sudhakar CB, Higgins RSD, Whitson BA. Donor selection in heart transplantation. J Thorac Dis 2014; 6:1097-104. [PMID: 25132976 DOI: 10.3978/j.issn.2072-1439.2014.03.23] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/17/2014] [Indexed: 01/17/2023]
Abstract
There is increased scrutiny on the quality in health care with particular emphasis on institutional heart transplant survival outcomes. An important aspect of successful transplantation is appropriate donor selection. We review the current guidelines as well as areas of controversy in the selection of appropriate hearts as donor organs to ensure optimal outcomes. This decision is paramount to the success of a transplant program as well as recipient survival and graft function post-transplant.
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Affiliation(s)
- Ahmet Kilic
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Sitaramesh Emani
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Chittoor B Sai-Sudhakar
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Robert S D Higgins
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Bryan A Whitson
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Bombardini T, Arpesella G, Maccherini M, Procaccio F, Potena L, Bernazzali S, Leone O, Picano E. Medium-term outcome of recipients of marginal donor hearts selected with new stress-echocardiographic techniques over standard criteria. Cardiovasc Ultrasound 2014; 12:20. [PMID: 24935114 PMCID: PMC4069096 DOI: 10.1186/1476-7120-12-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/11/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Heart transplantation is limited by severe donor organ shortage. Regardless of the changes made in the acceptance of marginal donors, any such mechanism cannot be considered successful unless recipient graft survival rates remain acceptable. A stress echo-driven selection of donors has proven successful in older donors with normal left ventricular resting function and in standard donors with reversible resting left ventricular dysfunction acutely improving during stress, or slowly improving (over hours) during intensive hormonal treatment. Aim of this study is to assess the medium-term outcome of recipients of marginal donor hearts selected with new echocardiographic techniques over standard criteria. METHODS AND RESULTS We enrolled 43 recipients of marginal donor hearts: age > 55 years, or < 55 years but with concomitant risk factors, n = 32; acutely improving during stress, n = 3; or slowly improving during hormonal treatment, n = 8. At follow-up (median, 30 months; interquartile range, 21-52 months), 37 of the recipients were still alive. One-year survival was 93%. CONCLUSION The strict use of new stress-echocardiographic techniques over standard criteria of marginal donor management, together with comprehensive monitoring of the donor, has the potential to substantially increase the number of donor hearts without adverse effects on recipient medium-term outcome.
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Affiliation(s)
- Tonino Bombardini
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy.
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Neurogenic Stress Cardiomyopathy in Heart Donors. J Card Fail 2014; 20:207-11. [DOI: 10.1016/j.cardfail.2013.12.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/15/2013] [Accepted: 12/18/2013] [Indexed: 11/20/2022]
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Bombardini T, Gherardi S, Leone O, Sicari R, Picano E. Transplant of stunned donor hearts rescued by pharmacological stress echocardiography: a "proof of concept" report. Cardiovasc Ultrasound 2013; 11:27. [PMID: 23915276 PMCID: PMC3735394 DOI: 10.1186/1476-7120-11-27] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 07/30/2013] [Indexed: 02/07/2023] Open
Abstract
Background Due to the shortage of donor hearts, the criteria for acceptance have been considerably expanded. Hearts with regional or global left ventricular dysfunction are excluded from donation, but stress echo might be useful to identify patients with reversible wall motion abnormalities, potentially eligible for donation. Methods Six marginal candidate donors (mean age, 40 ± 13 years; three men) were enrolled. Resting echocardiography showed in all subjects a LV ejection fraction ≥ 45% (mean 51 ± 5%), but multiple risk factors were present. All donors had either global or discrete wall motion abnormalities: Wall Motion Score Index (WMSI) rest = 1.33 ± 0.25. Stress echocardiography was performed with the dipyridamole high dose of 0.84 mg/kg given over 6 min. Results The stress echo results were abnormal in three donors (WMSI rest = 1.51 ± 0.19 vs peak = 1.41 ± 0.30). These hearts were excluded from donation and cardiac pathology verification was available in two cases of confirmed LV myocardial fibrosis and/or severe coronary stenosis. The remaining three hearts improved during stress (WMSI rest = 1.15 ± 0.13 vs peak = 1.04 ± 0.06) and were transplanted uneventfully. Recipients (three males, mean age 53 ± 4 years) underwent post-TX coronary angiography, IVUS and endomyocardial biopsies. No recipient had primary graft failure, and all showed normal coronary angiography and normal LV function (EF = 57 ± 6%; WMSI = 1 ± 0) at 1-month post-TX. The recipients were alive at 12-month median follow-up. Conclusions Dipyridamole stress echo performed in brain-dead potential donors with LV resting global or discrete wall motion abnormalities identifies hearts with severe morphologic abnormalities excluded from donation (with fixed response during stress echo) from hearts eligible for donation, showing improvement in regional wall motion during stress (viability response) and normal function and coronary anatomy following transplantation.
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Godino M, Lander M, Cacciatore A, Perez-Protto S, Mizraji R. Ventricular dysfunction associated with brain trauma is cause for exclusion of young heart donors. Transplant Proc 2010; 42:1507-9. [PMID: 20620464 DOI: 10.1016/j.transproceed.2010.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Ventricular dysfunction (VD) in the context of brain death (BD) is one medical cause that may be reversed to extend the range of donors for cardiac transplant programs. The aim of this study was to identify and quantify the causes for exclusion of potential heart donors and to define risk factors for VD among the BD population. MATERIALS AND METHODS This study of 100 heart-beating potential donors defined subjects as those younger than 50 years. We defined hemodynamic dysfunction (HD) as failure to achieve hemodynamic objectives despite the use of inotropic agents by protocol or upon diagnosing VD. RESULTS Among 246 BD subjects were 100 potential heart donors. Of these, 75 were transformed into real donors (RD) including 13 heart RD and 62 noncardiac RD. The conversion rate of BD subjects younger than 50 years to heart RD was 17%. When we analyzed the medical reasons for exclusion of the 62 donors who were not converted to heart RD, we observed that HD was the major cause (34%). When we analyzed the causes for exclusion related to cause of death, cranial trauma predominated (52%; P = .01; relative risk 3.5; 95% confidence interval 1.4-8.5). CONCLUSION Hemodynamic dysfunction represented the major cause for loss of heart donors; it was associated with younger patients with cranial trauma.
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Affiliation(s)
- M Godino
- Instituto Nacional de Donación y Transplante, Hospital de Clínicas, Montevideo, Uruguay.
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Höfer D, Aliabadi A, Ebner C, Hörmann C, Mahr S, Mascherbauer R, Pölzl G, Reiter A, Wasler A, Weber T, Zink M, Zuckermann A, Antretter H. [Evaluation of the potential organ donor with special regards to heart donation]. Wien Klin Wochenschr 2010; 122:441-51. [PMID: 20628904 PMCID: PMC7102121 DOI: 10.1007/s00508-010-1407-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 06/10/2010] [Indexed: 05/26/2023]
Abstract
Angesichts der auch in Österreich vorherrschenden Knappheit an verfügbaren Organspendern für Herztransplantationen erscheint es dringlich notwendig, eine Optimierung von Spenderevaluierung und Management zu diskutieren. In der vorliegenden Arbeit werden allgemeine Spenderkriterien und herzspezifische Parameter detailliert diskutiert und im Zusammenhang mit der internationalen Literatur dargestellt. Es wird der "marginale" und im Gegensatz dazu der "optimale" Organspender definiert. Das Spendermanagement wird besprochen, wobei neben der hämodynamischen Optimierung auch auf zusätzliche intensivmedizinische Aspekte eingegangen wird. Erst die exakte Evaluierung erlaubt die individuelle Zuteilung des Organs zum passenden Empfänger und stellt somit insbesondere bei marginalen Spendern die Grundlage eines Therapieerfolgs dar.
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Affiliation(s)
- Daniel Höfer
- Universitätsklinik für Herzchirurgie, Medizinische Universität Innsbruck, Innsbruck, Austria.
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Apostolakis E, Parissis H, Dougenis D. Brain Death and Donor Heart Dysfunction: Implications in Cardiac Transplantation. J Card Surg 2010; 25:98-106. [DOI: 10.1111/j.1540-8191.2008.00790.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hinojosa R, Herruzo A, Escoresca Ortega A, Jiménez P. Evaluación y mantenimiento del donante cardíaco. Med Intensiva 2009; 33:377-84. [DOI: 10.1016/j.medin.2009.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 03/30/2009] [Accepted: 03/30/2009] [Indexed: 01/15/2023]
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Use of hearts transplanted from donors with severe sepsis and infectious deaths. J Heart Lung Transplant 2009; 28:260-5. [PMID: 19285618 DOI: 10.1016/j.healun.2008.11.911] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 09/12/2008] [Accepted: 11/19/2008] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The reluctance to use organs from donors who have died from severe infections is based on the potential transmission of an infectious agent to the recipient and on the uncertainty about allograft function in the setting of severe donor sepsis. METHODS From 1999 to 2007, donor hospital records were reviewed which focused on microbiology cultures and sensitivity results; type and duration of antimicrobial therapy; hemodynamic data, results of echocardiogram, and imaging studies. Preliminary positive and negative results from pre-harvest blood, respiratory, urine, and cerebrospinal fluid cultures were verified with the procurement agency. The harvesting surgeon performed gross inspection of donor valvular structures. RESULTS Nine donor hearts were transplanted from patients who expired from community onset infections with severe septic shock, meningitis, and/or pneumonia caused by Streptococcus pneumoniae (n = 4), Streptococcus milleri (n = 2), Neisseria meningitidis (n = 2), and unidentified gram- positive cocci (n = 1). Four donors had probable infection-induced intracranial hemorrhage, and all donors were vasopressor-dependent before organ procurement. No evidence of donor-transmitted infection, sepsis, or rejection was observed, and long-term function remained excellent; allograft dysfunction in three patients resolved after transplant. Our series of nine donors represents approximately 1.3% of successfully transplanted cardiac allografts during the respective period of review. CONCLUSIONS Patients succumbing to severe infections (meningitis, pneumonia, and septic shock) should not be arbitrarily excluded for possible heart donation. Assessing the suitability of donors with severe infections requires flawless communication between the donor and transplant facility, including a comprehensive evaluation of donor infection and pathogen(s), severity of sepsis, adequacy of antimicrobial treatment, and the degree of sepsis-induced myocardial dysfunction.
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Abstract
Dobutamine stress echocardiography (DSE) is a reliable cardiac risk stratifier that has widespread applicability because of its clinical accuracy and cost effectiveness. Dobutamine has positive inotropic and chronotropic effects and is commonly used in patients who cannot exercise or achieve an adequate heart rate response with exercise. Recently available long-term results from several independent clinical trials, combined with enhancements in image quality, have improved the ability to detect significant coronary artery disease and determine myocardial viability. Dobutamine stress echocardiography has an excellent safety profile with clinical results superior to regular exercise electrocardiography and comparable with exercise echocardiography and radionucleotide perfusion stress imaging. Low-dose dobutamine response can accurately predict dysfunctional yet viable myocardial regions that may improve with revascularization. Clinical studies are now available refining the common use of DSE preoperatively in female patients with valvular disease, as well as in the emergency department. Dobutamine stress echocardiography does have some limitations in discriminating particular regions of ischemia when multiple ventricular segments are involved and when the imaging is suboptimal. It can be applied using minimal additional resources in an otherwise functioning echocardiography laboratory and, with appropriate training, can result in clinical results comparable with those of large-scale multicenter trials. Ongoing improvements in technology and the development of new reagents such as myocardial contrast agents hold promise for further advancement in the near future.
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Affiliation(s)
- B W Usher
- Medical Research Service, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA
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Effect of glucose-insulin-potassium in severe acute heart failure after brain death*. Crit Care Med 2008; 36:2740-5. [DOI: 10.1097/ccm.0b013e318186f64b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wittwer T, Wahlers T. Marginal donor grafts in heart transplantation: lessons learned from 25 years of experience. Transpl Int 2007; 21:113-25. [DOI: 10.1111/j.1432-2277.2007.00603.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Donor cardiac troponin I levels do not predict recipient survival after cardiac transplantation. J Heart Lung Transplant 2007; 26:1048-53. [PMID: 17919626 DOI: 10.1016/j.healun.2007.07.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2006] [Revised: 01/07/2007] [Accepted: 07/15/2007] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Serum levels of cardiac troponin I (cTnI) are frequently measured in the evaluation of potential heart donors. However, the utility of cTnI levels for predicting recipient outcomes remains controversial. This study was performed to determine whether donor cardiac cTnI levels exceeding 1.0 microg/liter are associated with adverse recipient outcomes. METHODS All donors managed by the California Transplant Donor Network between January 2001 and July 2002 with consent for donor evaluation and at least 1 measured cTnI level were included in the study if 1-year recipient mortality data were available. Each study subject was classified as having elevated cTnI if any level exceeded 1.0 microg/liter. Donor variables, recipient risk of 30-day and 1-year mortality, and recipient need for mechanical circulatory support were compared between the 2 groups. RESULTS A total of 263 potential donors were evaluated, and 98 had elevated cTnI levels. Of these potential donors, 139 were accepted for transplantation. The cTnI levels were normal in 96 and elevated in 43. Most donors (77%) with elevated cTnI levels had levels of less than 10 microg/liter. Donor cardiopulmonary resuscitation was associated with cTnI elevations. Donors with elevated cTnI levels did not require higher doses of inotropic drugs before transplantation and had similar hemodynamic profiles compared with donors with normal cTnI levels. Although there was a trend towards longer post-transplant hospitalization in recipients of grafts from donors with elevated cTnI levels (17 days vs 15 days, p = 0.044), there was no significant difference in the recipient need for mechanical circulatory support or 30-day and 1-year mortality between the 2 groups. CONCLUSIONS In this study, a modestly elevated donor cTnI was not associated with a higher risk of recipient mortality or need for post-transplant mechanical circulatory support. A potential donor heart should not be discarded solely because the troponin level is elevated.
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Venkateswaran R, Bonser R, Steeds R. Echocardiographic detection of dysfunctions in donor hearts. Future Cardiol 2007; 3:99-104. [PMID: 19804211 DOI: 10.2217/14796678.3.1.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Heart transplantation activity is steadily declining worldwide, despite initiatives to increase the donor pool. The yield of transplantable hearts remains low, leading to wastage of over two-thirds of donor organs. Accurate assessment and intervention is required to increase the number of transplantable hearts. The retrieval rate could be increased if techniques become available to differentiate between transplantable and nontransplantable hearts. Echocardiography is an ideally suited noninvasive investigation that may guide donor optimization. However, there are technical difficulties in acquiring high-quality views, and changes in ventricular function following catecholamine storm in brainstem death often lead to misinterpretation of standard 2D images. Current advances in technology, including the routine use of left ventricular contrast, 3D imaging and tissue doppler studies, may improve the accuracy, and thereby the utilization, of echocardiography in donor heart assessment.
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Affiliation(s)
- Rajamiyer Venkateswaran
- Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.
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Kutsogiannis DJ, Pagliarello G, Doig C, Ross H, Shemie SD. Medical management to optimize donor organ potential: review of the literature. Can J Anaesth 2006; 53:820-30. [PMID: 16873350 DOI: 10.1007/bf03022800] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Over the past two decades, the demand for donor organs continues to outpace the number of organs available for transplantation. Parallel with this has been a change in the demographics of organ donors with an increase in older donors and donors with marginal organs as a proportion of the total organ donor pool. Consequently, efforts have been made to improve the medical care delivered to potential organ donors to improve the conversion rate and graft survival of available organs. The purpose of this literature review is to provide updated recommendations for the contemporary management of organ donors after the neurological determination of death in order to maximize the probability of recipient graft survival. SOURCES A comprehensive review of the literature obtained through searches of MEDLINE/PubMed, and personal reference files. PRINCIPAL FINDINGS Contemporary management of the organ donor after neurological determination of death includes therapies to prevent the detrimental effects of the autonomic storm, the use of invasive hemodynamic monitoring and aggressive respiratory therapy including therapeutic bronchoscopy in marginal heart and lung donors, and the use of hormonal therapy including vasopressin, corticosteroids, triiodothyronine or thyroxine, and insulin for the pituitary failure and inflammation seen in brain dead organ donors. The importance of normalizing donor physiology to optimize all available organs is stressed. CONCLUSION Aggressive hemodynamic and respiratory management of solid organ donors, coupled with the use of hormonal therapy improves the rate of conversion and graft survival in solid organ recipients.
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Affiliation(s)
- Demetrios J Kutsogiannis
- Division of Critical Care Medicine and Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
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Chamorro C, Romera MA, Silva JA, Valdivia M, Ortega A. Análisis de los motivos de exclusión de la donación cardiaca. ¿Causas superables? Rev Esp Cardiol 2006. [DOI: 10.1157/13086080] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The existence of stunned myocardium and reversible myocardial dysfunction is widely described and accepted in patients suffering ischemic heart disease. However, it cannot be exclusive to coronary disease. Classically, the appearance of electrocardiographic changes in the critical neurological disease has been described. However, at present, it seems to be observed that some of these patients with critical neurological disease could have variable grades of myocardial dysfunction, which is generally reversible in the surviving patients. This myocardial dysfunction, which could affect critically ill neurological patients, has traits similar to stunned myocardium generated in coronary patients since: a) it is generally associated to electrocardiographic changes, b) it can be accompanied by segmental contractility disorders and even c) it may be accompanied by a certain increase of cardiac biomarkers. Although its etiopathogeny is unknown, it could be related with the severity of the primary neurological disease. Its prophylaxis and prognosis are also unknown. It could be related with neurogenic edema, with hemodynamic instability, and could also play a very important role in brain death and in organ donation.
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Affiliation(s)
- M Ruiz Bailén
- Unidad de Medicina Intensiva, Servicio de Cuidados Críticos y Urgencias, Complejo Hospitalario de Jaén, Hospital Universitario Médico Quirúrgico, España.
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Affiliation(s)
- Kenneth E Wood
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, USA.
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Abstract
The successes of thoracic transplantation have led to the expansion of indications and a subsequent growth in demand for a short supply of organs. In response to this disparity, the criteria for organ donation have been liberalized. Despite these difficult challenges, with advances in surgical techniques and perioperative care of both the donor and recipient, outcomes have continued to improve over time. This article focuses on the more recent surgical advances in donor selection and management, procurement and implantation, and the impact of these advances on patient outcome.
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Affiliation(s)
- Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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36
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Wu WC, Bhavsar JH, Aziz GF, Sadaniantz A. An overview of stress echocardiography in the study of patients with dilated or hypertrophic cardiomyopathy. Echocardiography 2004; 21:467-75. [PMID: 15209731 DOI: 10.1111/j.0742-2822.2004.03083.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Stress echocardiography is a useful noninvasive modality for measuring dynamic outflow gradient and contractility changes in patients with hypertrophic cardiomyopathy (HCM) or dilated cardiomyopathy (DCM). In patients with HCM, stress echocardiography may determine the degree of outflow tract obstruction at rest and with activity, can detect occult systolic dysfunction in symptomatic patients with a normal resting left ventricular ejection fraction, and can also be utilized to monitor the efficacy of treatment. In individuals suffering from DCM, stress echocardiography is an important aid in the evaluation of the etiology, diagnosis, and prognosis of the disease as well as the functional status of the patient during either exercise or simulated stress conditions. Dobutamine stress echocardiography, by providing a measurement of the myocardial reserve, is a useful tool to predict the systolic recovery and clinical outcome of patients with heart failure. The stress-induced change in the wall motion score index can also be used as an accurate alternative to predict the peak oxygen consumption rate and exercise capacity of the same patient population. Finally, stress echocardiography has also been used in the identification of the predilated phase of cardiomyopathy in individuals with high clinical suspicion of the disease.
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Affiliation(s)
- Wen-Chih Wu
- Division of Cardiology, Providence VA Medical Center, and The Miriam Hospital, Brown Medical School, Providence, Rhode Island 02908, USA.
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Drummond-Webb JJ, Schmitz ML, Johnson CE, Frazier EA. Expanding the donor pool: use of a donor heart having undergone recent cardiac surgery. J Heart Lung Transplant 2004; 23:639-40. [PMID: 15135384 DOI: 10.1016/j.healun.2003.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2003] [Revised: 05/28/2003] [Accepted: 05/28/2003] [Indexed: 10/26/2022] Open
Abstract
The current shortage of donor organs is a well-recognized global phenomenon. The goal of contemporary transplant practice is to optimize and expand the organ donor pool. Despite biologic and technologic advancements, the single most important limitation remains underutilization and non-recovery of potential organs. We report the use of a donor cardiac organ from a 5-year-old child who had undergone recent (<72 hours) closure of an atrial septal defect. The heart was harvested successfully and implanted with no apparent hemodynamic compromise.
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Affiliation(s)
- Jonathan J Drummond-Webb
- Pediatric Congenital Cardiac Surgery, Arkansas Children's Hospital and the University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202, USA.
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López-Navidad A, Caballero F. Extended criteria for organ acceptance. Strategies for achieving organ safety and for increasing organ pool. Clin Transplant 2003; 17:308-24. [PMID: 12868987 DOI: 10.1034/j.1399-0012.2003.00119.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The terms extended donor or expanded donor mean changes in donor acceptability criteria. In almost all cases, the negative connotations of these terms cannot be justified. Factors considered to affect donor or organ acceptability have changed with time, after showing that they did not negatively affect graft or patient survival per se or when the adequate measures had been adopted. There is no age limit to be an organ donor. Kidney and liver transplantation from donors older than 65 years can have excellent graft and patient actuarial survival and graft function. Using these donors can be from an epidemiological point of view the most important factor to esablish the final number of cadaveric liver and kidney transplantations. Organs with broad structural parenchyma lesion with preserved functional reserve and organs with reversible functional impairment can be safely transplanted. Bacterial and fungal donor infection with the adequate antibiotic treatment of donor and/or recipient prevents infection in the latter. The organs, including the liver, from donors with infection by the hepatitis B and C viruses can be safely transplanted to recipients with infection by the same viruses, respectively. Poisoned donors and non-heart-beating donors, grafts from transplant recipients, reuse of grafts, domino transplant and splitting of one liver for two recipients can be an important and safe source of organs for transplantation.
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Affiliation(s)
- Antonio López-Navidad
- Department of Organ & Tissue Procurement for Transplantation, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Ryan JB, Hicks M, Cropper JR, Garlick SR, Kesteven SH, Wilson MK, Feneley MP, Macdonald PS. Functional evidence of reversible ischemic injury immediately after the sympathetic storm associated with experimental brain death. J Heart Lung Transplant 2003; 22:922-8. [PMID: 12909474 DOI: 10.1016/s1053-2498(02)00558-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Acute brain death from increased intracranial pressure results in a transient increase in myocardial adenosine and lactate, which indicates that oxygen demand exceeds oxygen delivery during the sympathetic "storm". The aim of this study was to determine the functional significance of this period of ischemia. METHODS Brain death was inflicted on 40 Westran pigs (36.5-68.0 kg) by inflating a 21-ml subdural balloon over 3 minutes. In 38 animals, micromanometry and sonomicrometry were used to obtain left ventricular pressure-volume loops to determine the preload recruitable stroke work (PRSW) relationship. Data files were recorded before and at 15-minute intervals after beginning balloon inflation. Plasma troponin I was measured before and 60 minutes after beginning balloon inflation in the 38 instrumented and 2 non-instrumented animals. RESULTS All animals experienced the classical sympathetic storm. The slope of the PRSW relationship decreased, and the volume-axis intercept shifted to the right 15 minutes after beginning balloon inflation (p < 0.0001). Progressive incremental recovery (leftward shift) occurred between subsequent time points (p < or = 0.0018). In the instrumented animals, the mean plasma troponin I level increased from 1.4 +/- 1.6 microg/liter to 2.8 +/- 2.3 microg/liter (p < 0.001). However, troponin I was not detected before or after induction of brain death in the plasma of either non-instrumented animal (p = 0.001). CONCLUSIONS The sympathetic storm produced transient contractile dysfunction, consistent with ischemic injury. However, troponin I release reflected surgical instrumentation and not brain death.
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Affiliation(s)
- Jonathon B Ryan
- Heart and Lung Transplant Unit, St. Vincent's Hospital and the Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.
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Palac RT, Sumner G, Laird R, O'Rourke DJ. Reversible myocardial dysfunction after traumatic brain injury: mechanisms and implications for heart transplantation. Prog Transplant 2003. [PMID: 12688649 DOI: 10.7182/prtr.13.1.q3g22r74glgr565t] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Reversible myocardial dysfunction is known to occur in patients with cerebrovascular accidents and brain death. Several mechanisms for transient myocardial dysfunction have been proposed, including increased sympathetic activity, hormone depletion, and a reduction in coronary perfusion pressure. The relative importance of each of these mechanisms remains controversial. We report the case of a 19-year-old man who suffered traumatic brain death associated with reversible myocardial dysfunction despite elevated cardiac enzymes. Myocardial recovery occurred after correcting his hemodynamic instability and hypothermia emphasizing the importance of normalization of coronary perfusion pressure and core body temperature. The mechanisms for reversible myocardial dysfunction and their implications for heart transplantation following traumatic brain death are reviewed. A diagnostic strategy is proposed that would allow early recognition of reversible myocardial dysfunction in brain-dead patients.
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Zaroff JG, Rosengard BR, Armstrong WF, Babcock WD, D’Alessandro A, Dec G, Edwards NM, Higgins RS, Jeevanandum V, Kauffman M, Kirklin JK, Large SR, Marelli D, Peterson TS, Ring W, Robbins RC, Russell SD, Taylor DO, Van Bakel A, Wallwork J, Young JB. Maximizing use of organs recovered from the cadaver donor: cardiac recommendations1 1This article was originally published in Circulation. Copyright © 2002 American Heart Association, Inc. Reprinted with permission, Lippincott, Williams & Wilkins. J Heart Lung Transplant 2002. [DOI: 10.1016/s1053-2498(02)00526-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zaroff JG, Rosengard BR, Armstrong WF, Babcock WD, D'Alessandro A, Dec GW, Edwards NM, Higgins RS, Jeevanandum V, Kauffman M, Kirklin JK, Large SR, Marelli D, Peterson TS, Ring WS, Robbins RC, Russell SD, Taylor DO, Van Bakel A, Wallwork J, Young JB. Consensus conference report: maximizing use of organs recovered from the cadaver donor: cardiac recommendations, March 28-29, 2001, Crystal City, Va. Circulation 2002; 106:836-41. [PMID: 12176957 DOI: 10.1161/01.cir.0000025587.40373.75] [Citation(s) in RCA: 282] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The shortage of available donor hearts continues to limit cardiac transplantation. For this reason, strict criteria have limited the number of patients placed on the US waiting list to approximately 6000 to 8000 per year. Because the number of available donor hearts has not increased beyond approximately 2500 per year, the transplant waiting list mortality rate remains substantial. Suboptimal and variable utilization of donor hearts has compounded the problem in the United States. In 1999, the average donor yield from 55 US regions was 39%, ranging from 19% to 62%. This report provides the detailed cardiac recommendations from the conference on "Maximizing Use of Organs Recovered From the Cadaver Donor" held March 28 to 29, 2001, in Crystal City, Va. The specific objective of the report is to provide recommendations to improve the evaluation and successful utilization of potential cardiac donors. The report describes the accuracy of current techniques such as echocardiography in the assessment of donor heart function before recovery and the impact of these data on donor yield. The rationale for and specific details of a donor-management pathway that uses pulmonary artery catheterization and hormonal resuscitation are provided. Administrative recommendations such as enhanced communication strategies among transplant centers and organ-procurement organizations, financial incentives for organ recovery, and expansion of donor database fields for research are also described.
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Abstract
OBJECTIVE To review reversible myocardial dysfunction affecting critically ill patients without cardiac pathology. DATA SOURCES The bibliography for the study was compiled through a search of different databases for the period 1966-2001. References cited in the selected articles also were reviewed. STUDY SELECTION The selection criteria included all articles published on reversible myocardial dysfunction in critically ill patients. CONCLUSIONS Reversible myocardial dysfunction may develop in a situation of critical pathology, but the etiology of reversible myocardial dysfunction is not fully understood. This dysfunction may be accompanied by increases in enzyme concentrations and electrocardiographic changes. Reversible myocardial dysfunction probably is underdiagnosed, although its presence is associated with a worsening of the prognosis and with more specific therapeutic options. Further studies are necessary to define its true incidence and clinical implications.
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Affiliation(s)
- Manuel Ruiz Bailén
- Intensive Care Unit, Critical Care and Emergencies Department, Hospital de Poniente, El Ejido, Almería, Spain
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Abstract
Imaging algorithms in congenital heart disease, as in the patient with acquired heart diseases continue to evolve, with more and more information gleaned noninvasively. The emphasis will be on the newer aspects of imaging, not cross sectional echocardiography with color Doppler.
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Affiliation(s)
- J Russell
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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