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Is shortage of heart donors a real problem? Insights from a Brazilian Mid-West heart transplant program
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  • Fernando Atik,
  • Felipe Oliveira,
  • Pedro Peres,
  • Camila Moraes,
  • Marcelo Ulhoa,
  • Rodrigo Biondi,
  • Vitor Barzilai,
  • Renato Chaves,
  • Claudio da Cunha
Fernando Atik
Instituto de Cardiologia do Distrito Federal
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Felipe Oliveira
Instituto de Cardiologia do Distrito Federal
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Pedro Peres
Instituto de Cardiologia do Distrito Federal
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Camila Moraes
Instituto de Cardiologia do Distrito Federal
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Marcelo Ulhoa
Instituto de Cardiologia do Distrito Federal
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Rodrigo Biondi
Instituto de Cardiologia do Distrito Federal
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Vitor Barzilai
Instituto de Cardiologia do Distrito Federal
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Renato Chaves
Instituto de Cardiologia do Distrito Federal
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Claudio da Cunha
Instituto de Cardiologia do Distrito Federal
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Abstract

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.

Peer review status:Published

02 May 2020Submitted to Journal of Cardiac Surgery
04 May 2020Assigned to Editor
04 May 2020Submission Checks Completed
04 May 2020Reviewer(s) Assigned
19 May 2020Review(s) Completed, Editorial Evaluation Pending
19 May 2020Editorial Decision: Accept
Aug 2020Published in Journal of Cardiac Surgery volume 35 issue 8 on pages 1802-1810. 10.1111/jocs.14781