I wrote a press release recently on a study that showed a high percentage of donated hearts were not being used, raising concerns that some were getting wasted when they could be used to save lives. This made me curious about the process of just how a donor heart, which ideally has about a two-hour window before it gets transplanted to a patient with heart failure, gets matched.
The result is a Stanford Medicine magazine story titled "Heart Choices" that describes this process, the tough decisions that family members make when a loved one donates a heart, and the excruciating waiting that patients in need of a new heart go through.
Most importantly the article asks the question: Should more “high-risk” donor hearts be used? An estimated 20,000 people across the country are waiting for new hearts, and only a few thousand transplants happen on average per year. My story explains the dilemma:
The general assumption is that there simply are not enough donor hearts available to meet a growing demand. But new research is questioning that assumption. Some researchers and surgeons claim that thousands of donor hearts that could be used are turned away each year. The hearts are considered marginal because they come from older, sicker or riskier donors, but many argue they are safe for transplant, and could be saving lives.
"As patients wait longer, they often get sicker, and we often lose patients," says Stanford cardiologist Kiran Khush, MD, whose research reports that 65 percent of available heart donations are discarded because of stringent acceptance criteria. Yet the criteria have not been critically evaluated, she says. "Increasing the supply of donor hearts is, of course, a great concern of mine."
The process that matches recipients with donor hearts is complex. It’s somewhat amazing that it works at all. I tell the story of this process from the death bed of the dying donor to the heart transplant surgery of the recipient. The process begins with a phone call:
The first call is to report that a 40-something woman had suffered a large, hemorrhagic stroke. The second, to tell him about a young man who has shot himself in the head. Both are approved as potential heart donors.
And the process ends with a surgeon’s middle of the night decision:
When Texas-based heart surgeon Gonzalo Gonzalez-Strawinski, MD, gets a call from an organ procurement organization offering a donor heart, it’s usually the middle of the night, say around 3 a.m.
"When I get the call, I ask right then for the story," says Gonzalez-Strawinski, chief of heart transplantation at Baylor University Medical Center in Dallas. "At 3 in the morning you want to hear about it and get it done. They might say it’s a 26-year-old female who died of a gunshot wound to the head, who is currently in Nashville, Tennessee."
Gonzalez-Strawinski has a reputation for almost always saying yes to a donor heart - even most "high risk" hearts. What it comes down to is this, he says, "The guy who is donating the heart is definitely not on a heart transplant waiting list, so what’s the problem?”
I hope you'll read the full piece to learn more about this issue.
Previously: This summer’s Stanford Medicine magazine shows some skin, Growing number of donor hearts rejected for transplantation Stanford study finds, Moving the needle on organ donation, At Stanford Health Policy Forum, panelists dig into the issue of organ donation and Honoring a pioneer in heart transplant medicine
Illustration by Paul Blow