Donor heart refusal after circulatory death: An analysis of United Network for Organ Sharing refusal codes.

Autor:	Dann TM; Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.; Department of Surgery, Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, Mich., Spencer BL; Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.; Department of Surgery, Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, Mich., Wilhelm SK; Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.; Department of Surgery, Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, Mich., Drake SK; Information School, University of Wisconsin, Madison, Wis., Bartlett RH; Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.; Department of Surgery, Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, Mich., Rojas-Pena A; Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.; Department of Surgery, Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, Mich.; Department of Surgery, Section of Transplantation, University of Michigan Medical School, Ann Arbor, Mich., Drake DH; Department of Surgery, Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, Mich.; Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich.
Jazyk:	angličtina
Zdroj:	JTCVS open [JTCVS Open] 2024 Feb 27; Vol. 18, pp. 91-103. Date of Electronic Publication: 2024 Feb 27 (Print Publication: 2024).
DOI:	10.1016/j.xjon.2024.02.010
Abstrakt:	Objective: Donor hearts procured after circulatory death (DCD) may significantly increase the number of hearts available for transplantation. The purpose of this study was to analyze current DCD and brain-dead donor (DBD) heart transplantation rates and characterize organ refusal using the most up-to-date United Network for Organ Sharing (UNOS) and Organ Procurement and Transplantation Network data. Methods: We analyzed UNOS and Organ Procurement and Transplantation Network DBD and DCD candidate, transplantation, and demographic data from 2020 through 2022 and 2022 refusal code data to characterize DCD heart use and refusal. Subanalyses were performed to characterize DCD donor demographics and regional transplantation rate variance. Results: DCD hearts were declined 3.37 times more often than DBD hearts. The most frequently used code for DCD refusal was neurologic function, related to concerns of a prolonged dying process and organ preservation. In 2022, 92% (1329/1452) of all DCD refusals were attributed to neurologic function. When compared with DBD, DCD donor hearts were more frequently declined as the result of prolonged warm ischemic time (odds ratio, 5.65; 95% confidence interval, 4.07-7.86) and other concerns over organ preservation (odds ratio, 4.06; 95% confidence interval, 3.33-4.94). Transplantation rate variation was observed between demographic groups and UNOS regions. DCD transplantation rates are currently experiencing second order polynomial growth. Conclusions: DCD donor hearts are declined more frequently than DBD. DCD heart refusals result from concerns over a prolonged dying process and organ preservation. Heart transplantation rates may be substantially improved by ex situ hemodynamic assessment, adoption of normothermic regional perfusion guidelines, and quality initiatives. Competing Interests: D.H.D. reported patent royalties from Thompson Surgical Instruments. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (© 2024 The Author(s).)
Databáze:	MEDLINE
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