Determinants of donor heart acceptance and utilization in a Scandiatransplant center, 2012–2023
Dianna Jazera, Ida von Konow, Johan NilssonAbstract
Introduction
Across centers, donor heart acceptance practices vary, contributing to persistent donor shortages and waitlist mortality. A clearer understanding of which donor characteristics influence acceptance could lead to more efficient utilization.
Methods
This retrospective study was conducted on all donor hearts offered to Skåne University Hospital (SUS), Lund, Sweden, a Scandiatransplant member center, from 2012–2023 (age ≥15 years). Donor and transplantation characteristics were compared across accepted and declined offers, and logistic regression models were used to identify factors independently associated with utilization. Survival rates of recipients of donor hearts accepted and transplanted at SUS were compared with the survival of recipients of hearts declined by SUS but transplanted elsewhere within Scandiatransplant.
Results
Of 1417 offered donor hearts, 305 (21.5%) were accepted and transplanted at SUS and 201 were declined but transplanted elsewhere. Common decline causes included suboptimal graft quality and donor–recipient undersizing. Greater donor height (OR 1.64, 95% c.i. 1.41–1.91; P < 0.001) and weight (OR 1.14, 95% c.i. 1.04–1.24; P = 0.003) increased acceptance likelihood. Older age, female sex, hypertension, blood type AB, and left ventricular ejection fraction ≤50% were associated with decline after multivariable adjustments. 10-year overall recipient survival was numerically higher after donor hearts accepted and transplanted at SUS, than after declined donor hearts transplanted elsewhere (86% versus 75%; log-rank P = 0.103).
Discussion
Several donor characteristics influenced acceptance decisions, particularly donor size and cardiac function. Long-term survival did not differ statistically between recipients of donor hearts accepted at SUS and declined donor hearts transplanted elsewhere, although the study was not powered to establish equivalence.