Donor Heart Acceptance Practices Vary Across Transplant Centers

There is great variability in donor heart acceptance decisions among U.S. transplant centers, according to a study published online December in the American Journal of Transplantation.

Kiran K. Khush, M.D., and Robyn L. Ball, Ph.D., both from Stanford University in California, studied disparities in donor heart acceptance among U.S. transplant centers and their relations to posttransplant outcomes using potential transplant recipient match run and deceased donor data from the United Network for Organ Sharing (April 2007 to December 2015).

During the study period, there were 693,420 donor heart offers made. The researchers found great variability in donor heart acceptance practices among U.S. heart transplant centers, which reflects differential organ availability across regions of the country, differential willingness to accept organs that are perceived to be "high risk," and differential transplant center waiting-list sizes, clinical practices, and candidate characteristics. Donor and recipient characteristics were identified that were strongly associated with offer and acceptance of heart organs and organ sequence number, suggesting great variability in centers' willingness to accept less desirable donor hearts for critically ill candidates, especially those with prolonged waiting times. Several key risk factors that were highly predictive of donor heart nonuse and variability in acceptance across centers, including donor age, body mass index, blood urea nitrogen, and left ventricular ejection fraction, were not associated with increased recipient mortality.

"Low donor heart acceptance rates continue to result in allocation inefficiency, inequity in access to transplantation, and the discard of potentially suitable organs in the United States," the authors write.

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