Elevated Troponin? Take Heart and Reconsider!

Heart transplantation is a very effective treatment option for patients with many end-stage cardiac pathologies. Unfortunately, a shortage of donor organs limits the number of patients who benefit from this intervention, and many patients still die while awaiting transplantation. Per the Scientific Registry for Transplant Recipients, the estimated overall heart transplant wait-list mortality for 2013 was 10.7 deaths per 100 wait-list years.1 Given this, there has been great interest in identifying the donor risk factors that are significantly associated with adverse recipient outcomes, to safely expand donor heart utilization and to ensure that organs are not unnecessarily rejected.See Article by Madan et al When evaluating donor organs, there are a number of well-defined exclusion criteria, such as use of high-dose inotropic support during donor management, positive hepatitis/HIV serologies, obstructive coronary artery disease, and irreversible left ventricular systolic dysfunction.2 However, there are a number of donor risk factors that are evaluated on a case-by-case basis. Among these are elevated donor troponin I levels. Previous studies have shown that troponin I may be a reliable surrogate of donor heart function,3,4 and this biomarker has therefore been used to help select optimal organs. What is often not taken into consideration is the fact that donor troponin levels are influenced by a number of clinical variables, including mode of death and renal function.5 The Table lists the most commonly cited reasons for nonacceptance of donor hearts for transplantation.View this table:Table. Common …