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Lookup NU author(s): Professor John Dark
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© The Author(s) 2017/2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 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.
Author(s): Dimarakis I, Banner NR, Rushton S, Wong HSE, Berman M, Howell N, Payne J, Dark J, Mehew J, Venkateswaran R
Publication type: Article
Publication status: Published
Journal: European Journal of Cardio-thoracic Surgery
Year: 2018
Volume: 53
Issue: 6
Pages: 1135-1143
Print publication date: 01/06/2018
Online publication date: 22/01/2018
Acceptance date: 18/12/2017
ISSN (print): 1010-7940
ISSN (electronic): 1873-734X
Publisher: European Association for Cardio-Thoracic Surgery
URL: https://doi.org/10.1093/ejcts/ezx513
DOI: 10.1093/ejcts/ezx513
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