4th Fall Education Meeting
15 September to 17, 2002
Toward Optimizing Donor Heart Quality
Why do we need a measure of donor heart quality? Currently, there is a severe shortage of donor hearts available for transplantation, a substantial waiting period for a heart transplant, and a high mortality rate for those on the waiting list. Improved utilization of donor hearts is one target area that has been identified for addressing these problems. It has been reported that donor yield in some regions is as low as 19%. Aggressive donor management combined with carefully expanded criteria for donor heart suitability are critical issues that need to be addressed. A great deal of work has been going on in order to better understand the human donor heart. As a result it is clear that what we have assumed to be a “normal” or “low risk” donor heart is far from “normal”. The time is well overdue for us to focus on this pool of knowledge and the seek answers from it to the following five questions:
- Are we being too conservative in our guidelines for use of the human heart for transplantation?
- Can we propose a minimum standard or “quality” below which hearts should not be used?
- With such a standard can we move to objective descriptors of the donor hearts and so towards the confident use of distant teams to procure hearts for cardiac transplantation in our own hospitals?
- Can we optimize a “sub-optimal heart” through resuscitation and avoid the disposal of an increasingly vital resource?
- Can we look forward to an era when we can make certain and sensible use of donor hearts that we are currently rejecting?
This Fall Meeting of the ISHLT offers a wonderful opportunity for us to wrestle with these five challenging questions. It is hoped that following this meeting, we will be able to produce a paper describing how close we are to finding answers and as a result directing future work. In this way we may be more likely to ensure that heart transplantation does not become a rarity, failing to provide relief to those patients who have in all other ways reached the end of the road with heart failure.
