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Pediatric marginal donor hearts: Trends in US national use, 2005‐2014
Author(s) -
Morrison Adam K.,
Gowda Charitha,
Tumin Dmitry,
Phelps Christina M.,
Hayes Don,
Tobias Joseph,
Gajarski Robert J.,
Nandi Deipanjan
Publication year - 2018
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13216
Subject(s) - medicine , inotrope , ejection fraction , heart transplants , economic shortage , cardiology , heart transplantation , transplantation , heart failure , surgery , linguistics , philosophy , government (linguistics)
Pediatric patients awaiting heart transplant face high mortality rates due to donor organ shortages, including non‐use of marginal donor hearts. We examined national trends in pediatric marginal donor heart use over time. UNOS data were queried for heart donors <18 years from 2005 to 2014. The proportion of donor hearts considered marginal was determined using previously cited marginal characteristics: left ventricular ejection fraction ( LVEF ) <50%, use of ≥2 inotropes, cerebrovascular death, CDC high‐risk status, and eGFR < 30 mL/min/1.73 m 2 . Disposition of donor hearts was determined and stratified by marginal donor status. Of 6778 pediatric hearts offered from 2005 to 2014, 2373 (35.0%) were considered marginal. Non‐use of marginal donor hearts was significantly higher than that of donor hearts without any marginal characteristics (59.5% vs 20.3%, P < .001). In particular, LVEF < 50% and donor inotropes were associated with high rates of organ non‐use among pediatric donors. Yet, non‐use of marginal donor organs decreased from 67% to 48% from 2005 to 2014 ( P < .001). Although the proportion of pediatric donor hearts used for pediatric patients has increased, more than half of donor hearts are declined for use in pediatric recipients due, in part, to perceived marginal status.