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Is shortage of heart donors a real problem? Insights from a Brazilian Mid‐West heart transplant program
Author(s) -
Atik Fernando A.,
Oliveira Felipe B. M.,
Peres Pedro H. M.,
Moraes Camila S.,
Ulhoa Marcelo B.,
Biondi Rodrigo,
Barzilai Vitor S.,
Chaves Renato B.,
Cunha Claudio R.
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14781
Subject(s) - medicine , economic shortage , hazard ratio , confidence interval , heart transplants , proportional hazards model , heart transplantation , limiting , transplantation , demography , mechanical engineering , linguistics , philosophy , government (linguistics) , sociology , engineering
Background and Aim of the Study In developed countries, the shortage of viable donors is the main limiting factor of heart transplantation. The aim of this study is to determine whether the same reality applies to Brazil. Methods Between January 2012 and December 2014, 299 adult heart donor offers were studied in terms of donor profiles and reasons for refusal. The European donor scoring system was calculated, being high‐risk donors defined as more than 17 points. The donor scoring system was used to objectively determine the donor profile and correlate with donor acceptance and posttransplant primary graft dysfunction and recipient survival. Cox proportional hazard model was used in determining the predictors of long‐term mortality. Results The rates of donor acceptance and heart transplants performed were 45.8% and 19.3%, respectively. Reasons for refusal were mostly nonmedical (53.7%). The majority of donors were classified as high‐risk (65.5%). Hearts from high‐risk donors did not impact primary graft dysfunction (14.3% vs 10%; P = .6), neither long‐term survival ( P = .4 by logrank test). Recipient's age was greater than 50 years (hazard ratio, 6.02; 95% confidence interval, 2.41‐16.08; P < .0001) and was the only predictor of long‐term mortality. Conclusions The shortage of donors is not the main limiting factor of heart transplantation in the Mid‐West of Brazil. Nonmedical issues represent the main reason for organ discard. Most of the donors are classified as high risk which indicates that an expanded donor pool is a routine practice in our region, and donor scoring does not seem to influence to proceed with the transplant.