Ioannis Dimarakis1, Nicholas R Banner2, Sally Rushton3, Ha Sum Esther Wong3, Marius Berman4, Neil Howell5, John Payne6, John Dark7, Jenny Mehew3, Rajamiyer Venkateswaran1. 1. Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Wythenshawe Hospital, Manchester, UK. 2. Department of Cardiothoracic Transplantation, Harefield Hospital, Middlesex, UK. 3. Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK. 4. Department of Cardiothoracic Transplantation, Papworth Hospital, Cambridge, UK. 5. Department of Cardiothoracic Transplantation, Queen Elizabeth Hospital, Birmingham, UK. 6. Department of Transplantation, Golden Jubilee National Hospital, Clydebank, UK. 7. Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.
Abstract
OBJECTIVES: The optimum time after brainstem death (BSD) at which to assess the function of donor hearts is unknown. We hypothesized that a longer interval may be associated with a higher transplantation rate due to improved function. METHODS: Data were obtained from the UK Transplant Registry for the period between April 2010 and March 2015. The time when fixed dilated pupils were first noted in the donor was considered as the time of BSD. Retrieval was defined as the time when the abdominal organs were surgically perfused. RESULTS: BSD to retrieval duration was available for 1947 donors, of which 458 (24%) donated their heart. In the univariable analysis (not adjusting other donor risk factors), evidence was available to suggest that the BSD to cardiac assessment duration had a non-linear association with heart utilization (P < 0.0001). Adjusting for donor risk factors, the relationship remained with longer intervals being associated with increased transplantation (P = 0.0056). The modelled probability of heart utilization had a similar pattern to the observed rate of heart utilization. However, the probability of heart donation began to plateau after approximately 48 h. The analysis of the subset of donors attended by a cardiothoracic retrieval team showed a similar pattern. CONCLUSIONS: These data suggest that time interval from BSD to organ retrieval influences the heart retrieval rate. When the sole reason for declining a donor heart is poor function, a period of further observation and optimization up to 2 days should be considered.
OBJECTIVES: The optimum time after brainstem death (BSD) at which to assess the function of donor hearts is unknown. We hypothesized that a longer interval may be associated with a higher transplantation rate due to improved function. METHODS: Data were obtained from the UK Transplant Registry for the period between April 2010 and March 2015. The time when fixed dilated pupils were first noted in the donor was considered as the time of BSD. Retrieval was defined as the time when the abdominal organs were surgically perfused. RESULTS: BSD to retrieval duration was available for 1947 donors, of which 458 (24%) donated their heart. In the univariable analysis (not adjusting other donor risk factors), evidence was available to suggest that the BSD to cardiac assessment duration had a non-linear association with heart utilization (P < 0.0001). Adjusting for donor risk factors, the relationship remained with longer intervals being associated with increased transplantation (P = 0.0056). The modelled probability of heart utilization had a similar pattern to the observed rate of heart utilization. However, the probability of heart donation began to plateau after approximately 48 h. The analysis of the subset of donors attended by a cardiothoracic retrieval team showed a similar pattern. CONCLUSIONS: These data suggest that time interval from BSD to organ retrieval influences the heart retrieval rate. When the sole reason for declining a donor heart is poor function, a period of further observation and optimization up to 2 days should be considered.
Authors: Louise E See Hoe; Karin Wildi; Nchafatso G Obonyo; Nicole Bartnikowski; Charles McDonald; Kei Sato; Silver Heinsar; Sanne Engkilde-Pedersen; Sara Diab; Margaret R Passmore; Matthew A Wells; Ai-Ching Boon; Arlanna Esguerra; David G Platts; Lynnette James; Mahe Bouquet; Kieran Hyslop; Tristan Shuker; Carmen Ainola; Sebastiano M Colombo; Emily S Wilson; Jonathan E Millar; Maximillian V Malfertheiner; Janice D Reid; Hollier O'Neill; Samantha Livingstone; Gabriella Abbate; Noriko Sato; Ting He; Viktor von Bahr; Sacha Rozencwajg; Liam Byrne; Leticia P Pimenta; Lachlan Marshall; Lawrie Nair; John-Paul Tung; Jonathan Chan; Haris Haqqani; Peter Molenaar; Gianluigi Li Bassi; Jacky Y Suen; David C McGiffin; John F Fraser Journal: Intensive Care Med Exp Date: 2021-12-24