Introduction:
Cardiac transplantation remains the gold standard treatment for end
stage heart failure1, and despite the growing
prevalence of advanced heart failure in the United States, donor heart
supply critically limits rates of OHT2. This supply
and demand mismatch is magnified by the fact that over 50% of offered
donor hearts are not accepted for transplantation3.
The reduced utilization of certain donor hearts is largely tied to the
practice of rejecting organs that fall outside of strict donor selection
criteria. This approach has been adopted from literature that suggests
worse outcomes among recipients of certain donor types and concerns
regarding regulatory reprimand for transplant centers with more
pronounced mortality rates4. However, donor selection
is more nuanced than the strict donor guidelines suggest.
In addition to published donor selection criteria, other features must
be considered when selecting an appropriate donor. These include the
clinical status and interactions of the donor-recipient pair, as well as
the clinical volume and available infrastructure of the transplanting
center. Although each of these components may impact the overall success
of OHT with extended-criteria donor (ECD) hearts, higher transplant
center volumes have been linked to improved survival over lower volume
centers despite transplanting higher-risk
recipients5–8. Furthermore, higher volume OHT centers
may obtain a degree of their transplant volume by being more aggressive
on the acceptance of donor hearts outside of the standard criteria.
Considering the shortage of available donor hearts and that ECD hearts
may be an option to expand the available donor pool, we investigated if
the acceptance rates of ECD hearts varied among centers based on OHT
volume and if the acceptance of these organs impacted outcomes.