Variability in donor selection among pediatric heart transplant providers: Results from an international survey
Corresponding Author
Justin Godown
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
Correspondence
Justin Godown, Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, 2200 Children’s Way, Suite 5230 DOT, Nashville, TN 37232-9119.
Email: [email protected]
Search for more papers by this authorRichard Kirk
Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
Search for more papers by this authorAnna Joong
Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
Search for more papers by this authorAshwin K. Lal
Division of Pediatric Cardiology, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah
Search for more papers by this authorMichael McCulloch
Division of Pediatric Cardiology, University of Virginia Children’s Hospital, Charlottesville, Virginia
Search for more papers by this authorDavid M. Peng
Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, Ann Arbor, Michigan
Search for more papers by this authorJanet Scheel
Division of Pediatric Cardiology, St. Louis Children's Hospital, St. Louis, Missouri
Search for more papers by this authorRyan R. Davies
Department of Pediatric Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
Search for more papers by this authorAnne I. Dipchand
Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
Search for more papers by this authorOliver Miera
Division of Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Search for more papers by this authorJeffrey G. Gossett
Division of Pediatric Cardiology, UCSF Benioff Children's Hospitals, San Francisco, California
Search for more papers by this authorCorresponding Author
Justin Godown
Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
Correspondence
Justin Godown, Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, 2200 Children’s Way, Suite 5230 DOT, Nashville, TN 37232-9119.
Email: [email protected]
Search for more papers by this authorRichard Kirk
Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
Search for more papers by this authorAnna Joong
Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
Search for more papers by this authorAshwin K. Lal
Division of Pediatric Cardiology, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah
Search for more papers by this authorMichael McCulloch
Division of Pediatric Cardiology, University of Virginia Children’s Hospital, Charlottesville, Virginia
Search for more papers by this authorDavid M. Peng
Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, Ann Arbor, Michigan
Search for more papers by this authorJanet Scheel
Division of Pediatric Cardiology, St. Louis Children's Hospital, St. Louis, Missouri
Search for more papers by this authorRyan R. Davies
Department of Pediatric Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
Search for more papers by this authorAnne I. Dipchand
Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
Search for more papers by this authorOliver Miera
Division of Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Search for more papers by this authorJeffrey G. Gossett
Division of Pediatric Cardiology, UCSF Benioff Children's Hospitals, San Francisco, California
Search for more papers by this authorAbstract
There is considerable variability in donor acceptance practices among adult heart transplant providers; however, pediatric data are lacking. The aim of this study was to assess donor acceptance practices among pediatric heart transplant professionals. The authors generated a survey to investigate clinicians’ donor acceptance practices. This survey was distributed to all members of the ISHLT Pediatric Council in April 2018. A total of 130 providers responded from 17 different countries. There was a wide range of acceptable criteria for potential donors. These included optimal donor-to-recipient weight ratio (lower limit: 50%-150%, upper limit: 120%-350%), maximum donor age (25-75 years), and minimum acceptable left ventricular EF (30%-60%). Non-US centers demonstrated less restrictive donor selection criteria and were willing to accept older donors (50 vs 35 years, P < 0.001), greater size discrepancy (upper limit weight ratio 250% vs 200%, P = 0.009), and donors with a lower EF (45% vs 50%, P < 0.001). Recipient factors were most influential in the decision to accept marginal donors including recipients requiring ECMO support, ventilator support, and highly sensitized patients with a negative XM. However, programmatic factors impacted the decision to decline marginal donors including recent programmatic mortalities and concerns for programmatic restrictions from regulatory bodies. There is significant variation in donor acceptance practices among pediatric heart transplant professionals. Standardization of donor acceptance practices through the development of a consensus statement may help to improve donor utilization and reduce waitlist mortality.
CONFLICT OF INTEREST
The authors have no conflicts of interest related to the content of this manuscript to disclose.
Supporting Information
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