Consensus Statement PaperISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation
Section snippets
What is the waitlist mortality?
Current waitlist mortality varies by country, region, and institution. Published reports from large national and international datasets have consistently reported waitlist mortality between 17% and 30%. These include Japan (30%),2 Australia (22% mortality with 7% delisted for clinical deterioration),4 Eurotransplant (18%),5 and the United States of America (US, 17%).1 A contemporary survey of international organ procurement organizations (OPOs) showed waitlist mortality rates of 13% to 25% (
What is the current donor discard rate?
There is no standard definition of organ discard across organizations or countries, making it difficult to quantify and make comparisons. Organs may be discarded because potential organ donors were not evaluated for organ donation or were evaluated without assessing the heart, the heart was evaluated but not offered (or not reassessed for suitability to offer), an accepted organ was retrieved but not transplanted, or a donor heart was offered but not accepted for transplantation. The first 3
How much do donor characteristics affect outcomes?
The impact of donor characteristics and comorbidities on pediatric heart transplant outcomes remains challenging because of the low quality of available evidence. The literature, however, is consistent in that recipient factors far outweigh donor factors in influencing short- and long-term outcomes. The term marginal donor is often used but donor quality assessment is imprecise,16 hard evidence lacking, and the variety of criteria used to define a marginal donor for the most part is not
Can we improve donor management?
Management of pediatric donors primarily focuses on measures to mitigate the pathophysiologic responses to brain death.104, 105, 106 A recent consensus statement by the Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations made recommendations for both adult and pediatric donors.105 Early, targeted management of the potential donor can increase the number of available donor hearts without a deleterious effect on post-transplant
How do recipient and donor interactions affect outcomes?
Limited data exist on the interplay between the recipient and donor variables but do suggest there is likely a combination of factors at play.25,116, 117, 118, 119 Recipient factors appear to influence transplant outcomes more64 and has been clearly shown in adults (Table 2).118 Despite this evidence, it is common for physicians to accept marginal donors for recipients who are at higher risk. Examples are a patient deemed too sick to continue to wait, for example, on ECMO, not a ventricular
Behavioral science, programmatic, and regulatory influences
Behavioral science and the psychology of decision making provide insights into human behavior and explain why choices often deviate from rational predictions.125, 126, 127 There are several key concepts in behavioral economics and decision psychology that apply to decision making in transplantation.
Conclusions and recommendations
- 1.
The most important donor information is the echocardiographic measurement of EF. When normal, most other donor factors become irrelevant.
- 2.
It is reasonable to consider donor hearts when the EF is abnormal and/or with focal segmental wall motion abnormalities, but no strong recommendations can be made. Consideration of other factors may play a role in decision making, including the wishes of the recipient or family.
- 3.
There are notable differences in echocardiographic interpretations between local
Disclosure statement
The authors have no conflicts of interest to disclose. This manuscript received no funding.
References (140)
- et al.
Inferior outcomes on the waiting list in low-volume pediatric heart transplant centers
Am J Transplant
(2017) - et al.
Incidence and risk factors for mortality in infants awaiting heart transplantation in the USA
J Heart Lung Transplant
(2009) - et al.
Heart transplant outcomes in patients with left ventricular non-compaction cardiomyopathy
J Heart Lung Transplant
(2015) - et al.
Outcomes of children with restrictive cardiomyopathy listed for heart transplant: a multi-institutional study
J Heart Lung Transplant
(2009) - et al.
Outcomes of children with cardiomyopathy listed for transplant: a multi-institutional study
J Heart Lung Transplant
(2009) - et al.
Evolution and impact of ventricular assist device program on children awaiting heart transplantation
Ann Thorac Surg
(2015) - et al.
Pediatric heart transplant waiting list mortality in the era of ventricular assist devices
J Heart Lung Transplant
(2015) - et al.
Pediatric transplantation using hearts refused on the basis of donor quality
Ann Thorac Surg
(2009) - et al.
Systematic donor selection review process improves cardiac transplant volumes and outcomes
J Thorac Cardiovasc Surg
(2016) - et al.
The Registry of the International Society for Heart and Lung Transplantation: twentieth pediatric heart transplantation report-2017; focus theme: allograft ischemic time
J Heart Lung Transplant
(2017)
Interaction of older donor age and survival after weight-matched pediatric heart transplantation
J Heart Lung Transplant
The number of refusals for donor organ quality does not impact heart transplant outcomes in children
Ann Thorac Surg
Donor scoring system for heart transplantation and the impact on patient survival
J Heart Lung Transplant
Pediatric cardiac transplantation using hearts previously refused for quality: a single center experience
Am J Transplant
The international society of heart and lung transplantation guidelines for the care of heart transplant recipients
J Heart Lung Transplant
Pediatric Heart Donor Assessment Tool (PH-DAT): a novel donor risk scoring system to predict 1-year mortality in pediatric heart transplantation
J Heart Lung Transplant
Low ejection fraction in donor hearts is not directly associated with increased recipient mortality
J Heart Lung Transplant
AST Infectious Diseases Community of Practice. Donor-derived infections in solid organ transplantation
Am J Transplant
Intrathoracic organ transplantation from donors with meningitis: a single-center 20-year experience
Ann Thorac Surg
Use of organs from donors with bloodstream infection, pneumonia, and influenza: results of a survey of infectious diseases practitioners
Transpl Infect Dis
First case of Mycobacterium tuberculosis transmission by heart transplantation from donor to recipient
Int J Med Microbiol
Nucleic acid testing of organ donors: is the glass half empty or half full?
Am J Transplant
Nucleic acid testing (NAT) of organ donors: is the ”best” test the right test? A consensus conference report
Am J Transplant
Transmission of dengue virus from deceased donors to solid organ transplant recipients: case report and literature review
Braz J Infect Dis
Screening for Zika virus in deceased organ donors in Florida
Am J Transplant
Toxoplasma gondii serology and outcomes after heart transplantation: contention in the literature
Transplant Proc
Donor-derived Strongyloides stercoralis infection in solid organ transplant recipients in the United States, 2009-2013
Am J Transplant
Screening and treatment of Chagas disease in organ transplant recipients in the United States: recommendations from the Chagas in transplant working group
Am J Transplant
Coccidioidomycosis transmission Through organ transplantation: A report of the OPTN Ad Hoc Disease Transmission Advisory Committee
Am J Transplant
The impact of donor and recipient renal dysfunction on cardiac allograft survival: insights Into reno-cardiac interactions
J Card Fail
Cardiac transplantation can be safely performed using selected diabetic donors
J Thorac Cardiovasc Surg
Acquired donor peanut allergy From lung transplantation resulting in respiratory failure: A case report
Transplant Proc
Donor-transmitted malignancies in organ transplantation: assessment of clinical risk
Am J Transplant
Heart donors with underlying genetic syndromes
J Heart Lung Transplant
Impact of cardiac arrest resuscitated donors on heart transplant recipients’ outcome
J Thorac Cardiovasc Surg
Mortality and morbidity after retransplantation after primary heart transplant in childhood: an analysis from the registry of the International Society for Heart and Lung Transplantation
J Heart Lung Transplant
Does Donor cardiopulmonary resuscitation Time Affect Heart Transplantation Outcomes and Survival?
Ann Thorac Surg
The viability of transplanting organs from donors who underwent cardiopulmonary resuscitation: A systematic review
Resuscitation
Clinical factors implicated in primary graft dysfunction After heart transplantation: A single-center experience
Transplant Proc
High-dose catecholamine donor support and outcomes after heart transplantation
J Heart Lung Transplant
Effects of donor pre-treatment with dopamine on survival after heart transplantation: a cohort study of heart transplant recipients nested in a randomized controlled multicenter trial
J Am Coll Cardiol
Outcomes After transplantation of donor hearts With improving left ventricular systolic dysfunction
J Am Coll Cardiol
Recommendations for use of marginal donors in heart transplantation: Brazilian Association of Organs Transplantation guideline
Transplant Proc
Primary graft failure after heart transplantation: the importance of donor pharmacological management
Transplant Proc
Donor brain death mechanisms and outcomes After heart transplantation
Transplant Proc
The Registry of the International Society for Heart and Lung Transplantation. fifteenth pediatric heart transplantation report—2012
J Heart Lung Transplant
Outcomes of heart transplantation using donor hearts from infants with sudden infant death syndrome
J Heart Lung Transplant
Reliability of echocardiographic measurements of left ventricular systolic function in potential pediatric heart transplant donors
J Heart Lung Transplant
Reliability of transthoracic echocardiogram interpretation in potential adult heart transplant donors
J Heart Lung Transplant
Assessment of potential heart donors: A statement from the French heart transplant community
Arch Cardiovasc Dis
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Endorsed by the International Pediatric Transplant Association, Pediatric Heart Transplant Society, and The Transplantation Society