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Growing number of donor hearts rejected for transplantation, Stanford study finds

KhushAs a health writer, I’ve interviewed and written about numerous heart patients whose lives were saved when someone else died and donated their hearts for transplantation.

Those patients expressed both the anguish of hoping and praying for a new heart — when that means someone else has to die — and the overwhelming gratefulness for those donor hearts that saved their lives.

So when I wrote a story about a new Stanford study that shows an increasing number of donor hearts being rejected for transplantation, it struck a chord.

The study, published today online in the American Journal of Transplantation, found that the number of hearts rejected for transplant by surgeons and transplant centers is on the rise despite the growing need for such organs. As cardiologist Kiran Khush, MD, the lead author of the study, said in my story on the work, "We've become more conservative over the past 15-20 years in terms of acceptance, which is particularly troubling because of the national shortage of donor hearts and the growing number of critically ill patients awaiting heart transplantation."

Khush and her colleagues sought to study national trends in donor-heart use by examining data from the federal government’s Organ Procurement and Transplantation Network on all donated hearts from 1995-2010. Of 82,053 potential donor hearts, 34 percent were accepted and 48 percent were declined. The remainder were used for other purposes such as research.

The researchers found a significant decrease in donor heart acceptance, from 44 percent in 1995 to 29 percent in 2006, which rebounded slightly to 32 percent in 2010. They also found, as I wrote in the story:

Among a portion of donor hearts that are referred to as "marginal" — those with undesirable qualities, such as being small or coming from an older donor — their use in transplantation varied significantly across geographical regions depending on choices made by the surgeons and the transplant centers.

The study explored possible reasons for so few organs being accepted. Increasing scrutiny by regulatory agencies of the 140 or so transplant centers across the country may have had the unintended result of making surgeons and centers more risk averse and as a result reject more hearts. Also, an increasing us of mechanical circulatory support devices that help keep patients alive while waiting for donor hears, may cause surgeons to wait longer for “better hearts.”

What’s particularly interesting is that there's little research to show that use of these "marginal" donor hearts is dangerous. As the researchers wrote in the study:

Little evidence is available to support the expectation that the use of higher-quality donor hearts either increases life expectancy in heart transplant patients or decreases adverse effects. Any slight improvement noted must be weighed against the risk of a patient dying while waiting for a heart.

The researchers are calling for a new set of consistent, scientifically based guidelines to provide a standardized method of deciding whether a donor heart should be used for transplantation. As study co-author John Nguyen, who is trained as a nurse and works as part of a clinical team at the Oakland-based California Transplant Donor Network, told me:

There is likely a significant number of suitable donor hearts that are not getting used. Creating a more systematic way of evaluating these hearts based on scientific evidence could increase the number of heart transplants.

Previously: Stanford Children's heart transplant family featured tonight on Dateline; Honoring a pioneer in heart transplant medicine and Moving the needle on organ donation
Photo of Khush by Norbert von der Groeben

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