Heart transplantation outcomes from cardiac arrest–resuscitated donors
Section snippets
Methods
The United Network for Organ Sharing (UNOS) collects data on heart donors and recipients from all transplant centers across the USA. Since May 1994, CPR status of all potential donors was included in the set of donor variables and we dated our data query to that date. From May 1994 to July 2012, there were 29,242 heart transplantations performed in the USA. All data on donor and recipient variables were collected and analyzed by dividing them into 2 groups: a CPR+ donor group and a CPR− donor
Results
Of the 29,242 adult heart transplantations performed in the USA during the study period, 1,396 patients (4.7%) received hearts from CPR+ donors. Donor characteristics are summarized in Table 1. Mean age of donors in the CPR+ group was 25.5 ± 15 years vs 28.5 ± 14 years in the CPR− group (p < 0.0001). There were significantly more female donors in the CPR+ group. Anoxia as a cause of death was significantly more common in the CPR+ group, whereas stroke was more common in the CPR− group. All
Discussion
It is important to find every opportunity to optimize utilization of donor organs in the face of a steady rise in the number of patients waiting for heart transplantation. Cardiopulmonary arrest and resuscitated organ donors represents one of the underutilized groups.8 Our study has shown that accepting a heart from CPR+ donor did not result in poor outcomes for the recipient at 30-day, 1-year and 5-year intervals. In addition, duration of CPR had no adverse impact on recipient survival, both
Disclosure statement
The authors have no conflicts of interest to disclose.
We thank UNOS for providing us with the data for this project. We also thank Professor Anthony Minisi, MD, for advice and editorial assistance in revising the manuscript.
References (20)
- et al.
Scientific registry of the International Society for Heart and Lung Transplantation: introduction to the 2011 annual reports
J Heart Lung Transplant
(2011) - et al.
Does heart transplantation confer survival benefit in all risk groups?
J Heart Lung Transplant
(2005) Reperfusion of the ischemic myocardium
J Mol Cell Cardiol
(1977)- et al.
Preconditioning the human myocardium
Lancet
(1993) - et al.
Brain death effects on catecholamine levels and subsequent cardiac damage assessed in organ donors
J Heart Lung Transplant
(2009) - et al.
Paradoxical effects of brain death and associated trauma on rat mesenteric microcirculation: an intravital microscopic study
Clinics (Sao Paulo)
(2012) - Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR...
- et al.
Renal transplants using expanded cadaver donor criteria
Ann Transplant
(2004) - et al.
Donors with cardiac arrest: improved organ recovery but no preconditioning benefit in liver allografts
Transplantation
(2003) - et al.
Impact of donor cardiopulmonary resuscitation on pediatric heart transplant outcome
Pediatr Transplant
(2011)
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