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Reasons for refusing a donor heart for transplantation in Brazil
Author(s) -
Feldman André,
Marcelino César Augusto Guimarães,
Beneli Prado Layse,
Fusco Carine Cristiane,
Araújo Mara Nogueira,
Ayoub Andrea Cotait,
Almeida Antônio Flávio Sanchez
Publication year - 2016
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12747
Subject(s) - medicine , transplantation , exact test , heart transplantation , hemodynamics , retrospective cohort study , cardiology , surgery
Background Major advances have been made in heart transplantation, but there is a discrepancy between the number of patients potentially treatable by transplantation and the limited number of viable grafts. The aim of this study was to evaluate the reasons for refusal of donor hearts. Methods This was a retrospective analysis of donor data from an organ procurement organization in the state of São Paulo (Brazil) between 2010 and 2012. Fisher's exact test, Student's t‐test, and the Mann–Whitney U‐test were used in the statistical analysis. Results Only 26 (7.9%) of 328 potential heart donors actually became donors. Most donors were men (18/26, 69.2%), Caucasians (14/26, 53.8%), and had a mean age of 23.5 yr. There were significant associations of use of donor hearts with the variables: brain death after trauma (p = 0.002), history of hypertension (p = 0.001), electrocardiographic changes (p = 0.007), and age (p = 0.001). Older age (n = 101, 33.4%) was the main reason for refusal of donor hearts, followed by poor medical history (n = 44, 14.6%), cardiac arrest of the donor during donor care (n = 25, 8.3%), use of vasopressor drugs (n = 23, 7.6%), and hemodynamic instability (n = 20, 6.6%). Conclusions Age, poor medical history, cardiac arrest, use of vasopressors, and hemodynamic instability were the most prevalent reasons for refusal of donor hearts. Echocardiogram evaluation is a potential intervention to improve heart transplantation conversion in Brazil.