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Successful use of undersized donors for orthotopic heart transplantation—with a caveat

1994; Elsevier BV; Volume: 57; Issue: 6 Linguagem: Inglês

10.1016/0003-4975(94)90103-1

1552-6259

Lorne H. Blackbourne, Curtis G. Tribble, Scott E. Langenburg, Kimberly N. Sinclair, Gernot Rücker, Barry Chan, William D. Spotnitz, James D. Bergin, Irving L. Kron,

Hemodynamic Monitoring and Therapy

Accepted clinical practice has been to require body weights to be within 20% as a criterion for matching donor to recipient for cardiac transplantation.From November 1989 through September 1993 we began accepting larger differences in body weight between donor and recipient with 80 orthotopic heart transplants performed.Twenty-eight of these transplants used undersized donors (donor-to-recipient body weight ratio [DRBW] of 0.6 to 0.8) with the remaining donors being either size matched (DRBW = 0.8 to 1.0) or oversized (DRBW > 1.0).Thirty-three of the 80 transplant recipients (41%) were classified preoperatively as United Network for Organ Sharing (UNOS) status I and the remaining paeart transplantation is now an established treatment H modality for end-stage heart disease.The severe shortage of donor organs has been well publicized with up to 30% of patients dying while awaiting an appropriate donor organ [l, 21.Investigators have been questioning the restrictive but widely accepted donor criteria to meet the increasing demand for donor thoracic organs [l, 31.Following the assumption that the donor-to-recipient body weight ratio reflects the donor-to-recipient heart size ratio, most transplant centers limit donors to those with a body weight within *20% of the recipient's body weight [>6].Previously we have shown in an echocardiographic study that body weight does not correlate well with adult cardiac size in individuals weighing 50 to 100 kg [7].Thus, minimal differences appear to exist in heart sizes of the adult donor population and the traditional guidelines for donor body weight may be excessively restrictive.On the basis of this background we developed the hypothesis that the donor weight guidelines could be expanded safely and significantly, thus allowing greater discrepancies between donor and recipient weights.Expanding the existing guidelines should decrease the waiting period for donor hearts.We reviewed our experience with 80 consecutive heart transplant patients to test our hypothesis.