Embed Size (px)
Citation preview
Editorial
More Donors Are Available—Why Don’t WeUse Them?
R. E. Chinnock*
Department of Pediatrics, Loma Linda University,Loma Linda, California*Corresponding author: Richard E. Chinnock,[email protected]
Received 25 January 2013, revised 16 February 2013and accepted 23 February 2013
Children listed for heart transplantation face the highest
wait-list mortality, at about 20%, of any solid organ
transplant recipients (1). In light of this disturbing number,
it is equally disturbing that only about half of all potential
pediatric heart donors are utilized. Easterwood et al., in this
edition of the journal, have provided their experience
comparing donors who were turned down by other centers
for poor donor quality with donors that they accepted
primarily for transplantation (2). This joins our own recently
published evaluation demonstrating the same finding, with
a somewhat younger recipient pool (3). It is also consistent
with a recent report (4) which detailed the lack of impact of
CPR on the utility of the donor and a report from early in our
experience where we reported the successful use of the
dysfunctional donor heart (5).
In light of these reports, one thenmust ask—Why there are
still so many donors who are turned down for transplanta-
tion? I believe the answer likely lies in the experience of
many centerswith a 10–15% incidence of early graft failure,
often requiring ECMO to salvage the donor heart. In
addition, since the number of transplants performed at any
one center is small, one bad result can have a significant
adverse impact on an individual center’s outcomes. With
this in mind, and in particular for the child listed as UNOS
status 2, there is an understandable reluctance to use what
is perceived to be a marginal donor. And yet 50% of
potential donors are not used in the face of 20% pre-
transplant mortality.
What should be the response of the pediatric heart
transplant community? The current report by Eastwood
et al. is a helpful contribution to the conversation. However,
the process of decidingwho is andwho is not an acceptable
donor is too often shrouded in personal experience and
anecdote. It is time that a deeper, prospective multi-center
evaluation be undertaken to establish just what param-
eters, both from the donor (e.g. the use of biomarkers) (6)
and the recipient, will maximize the outcome in pediatric
heart transplantation.
Disclosure
The author of this manuscript has no conflicts of interest to
disclose as described by the American Journal of
Transplantation.
References
1. Almond CS, Thiagarajan RR, Piercey GE, et al. Waiting list mortality
among children listed for heart transplantation in the United States.
Circulation 2009; 119: 717–727.
2. Easterwood R, Singh RK, McFeely ED, et al. Pediatric cardiac
transplantation using hearts previously refused for quality: A single
center experience. Am J Transplant 2013; 13: 1484–1490.
3. Bailey LL, Razzouk AJ, Hasiniya NW, et al. Pediatric transplantation
using hearts refused on the basis of donor quality. Ann Thorac Surg
2009; 87: 1902–1909.
4. L’Ecuyer T, Sloan K, Tang L. Impact of donor cardiopulmonary
resuscitation on pediatric heart transplant outcome. Pediatr
Transplant 2011; 15: 742–745.
5. BoucekMM,Mathis CM, KanakriyehMS, et al. Donor shortage: Use
of the dysfunctional donor heart. J Heart Lung Transplant 1993; 12 (6
Pt 2): S186–S190.
6. DronavalliVB,BannerNR,BonserRS.Assessmentof thepotentialheart
donor: A role for biomarkers? J Am Coll Cardiol. 2010; 56: 352–361.
American Journal of Transplantation 2013; 13: 1382Wiley Periodicals Inc.
�C Copyright 2013 The American Society of Transplantationand the American Society of Transplant Surgeons
doi: 10.1002/ajt.12245
1382
