Is shortage of heart donors a real problem? Insights from a Brazilian
Mid-West heart transplant program
Background and aim of the study: In developed countries, the shortage of
viable donors is the main limiting factor of heart transplantation. The
aim of this study is to determine whether the same reality applies to
Brazil. Methods: Between January 2012 and December 2014, 299 adult heart
donor offers were studied in terms of donor profiles, and reasons of
refusal. European donor scoring system was calculated, being high-risk
donors defined as >17 points. Donor scoring system used to
objectively determine the donor profile and correlate with donor
acceptance and post-transplant primary graft dysfunction and recipient
survival. Cox proportional hazard model was used in determining
predictors of long-term mortality. Results: Rate of donor acceptance and
heart transplants performed were 45.8% and 19.3%, respectively.
Reasons for refusal were mostly non-medical (53.7%). The majority of
donors were classified as high-risk (65.5%). Hearts from high-risk
donors did not impact on primary graft dysfunction (14.3% vs 10%,
P=0.6), neither on long-term survival (P=0.4 by log-rank test).
Recipient’s age greater than 50 years (HR 6.02, CI95% 2.41 – 16.08,
P<0.0001) was the only predictor of long-term mortality.
Conclusions: Shortage of donors is not the main limiting factor of heart
transplantation in Mid-West of Brazil. Non-medical issues represent the
main reason of organ discard. Most of the donors were classified as
high-risk which indicates that an expanded donor pool is a routine
practice in our region, and donor scoring does not seem to influence to
proceed with the transplant.