EXPANDing the donor pool: Quantifying the Potential Impact of a Portable Organ Care System for Expanded Criteria Heart Donation

Despite the widespread use of mechanical circulatory support systems, modern optimal drug therapy and various interventional methods of heart transplantation remain the "gold standard" for the treatment of end-stage heart failure patients.At the same time the required number of heart transplants is significantly increasing due to the progressively increasing number of patients needing transplants and the actual donor pool. In recent years there has been a trend towards the increase in the number of recipients and the decrease in the number of donor organs. However, the use of donor hearts with pathological changes, including left ventricular myocardial hypertrophy, remains a controversial topic. It is believed that the use of expanded criteria significantly increases the risk of graft failure in the post-transplant period and leads to deterioration of immediate and long-term results. This work aimed to analyze the data on using donor hearts with left ventricular myocardial hypertrophy for allotransplantation.Authors declare no conflict of interest.

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Modern ideas in heart donor selection criteria

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2020-3-174-181 ◽

2020 ◽

Vol 22 (3) ◽

pp. 174-181

Author(s):

E. A. Tenchurina ◽

M. G. Minina

Keyword(s):

Selection Criteria ◽

Objective Assessment ◽

Donor Selection ◽

Donor Heart ◽

Donor Pool ◽

Heart Donor ◽

Expanded Criteria ◽

Expanded Criteria Donors ◽

Pair Analysis ◽

Selection Of

With the limited capacity of the available donor pool and the simultaneously growing demand for heart transplantation, expanding the heart donor selection criteria as one of the ways of increasing the availability of organ transplantation, and particularly donor heart, has become a challenge. On one hand, the use of expanded criteria donors increases the number of transplants and reduces the time spent on the waiting list. On the other hand, however, it increases the risk of adverse transplant outcomes. Accordingly, high-risk donors require a more thorough objective assessment using predictive models, while organs obtained from expanded criteria donors, require optimal selection of a donor-recipient pair. Analysis of global and national studies presented in this review reveals the depth of the current problem of heart donor selection.

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Preservation and perfusion rehabilitation of donor organs: achievements of the last decade

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2020-48-038 ◽

2020 ◽

Vol 48 (3) ◽

pp. 193-206

Author(s):

O. N. Reznik ◽

A. E. Skvortsov ◽

Ya. G. Moysyuk

Keyword(s):

State Of The Art ◽

Liver Graft ◽

Tissue Cell ◽

Machine Perfusion ◽

Donor Organ ◽

Functional Rehabilitation ◽

Donor Pool ◽

Renal Graft ◽

Expanded Criteria ◽

Donor Organs

At present, it is widely recognized that machine perfusion allows for a decreased rate of delayed function of the renal graft and of the risk of liver graft early dysfunction. The aim of the review is to present the actual changes of the donor pool related to prevailing numbers of donors by expanded criteria, to determine the prospects of expanding of the available donor pool based on their selection, as well as development of functional rehabilitation and modification at tissue, cell and molecular levels with the help of perfusion technologies. The article presents the state-of-the art view on the mechanisms of ischemic-reperfusion injury of donor organs, delineates the trends in the maintenance of their viability, and gives the literature data on the role and outlook of perfusion methods in organ transplantation. The authors provide the rationale for a comprehensive systemic approach to the assessment of the functional status of a donor organ with any baseline parameters and discuss a number of theoretical provisions on the implementation of a personalized perfusion approach to ensure the availability of transplantation care.

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Decreasing Trend of Terminations for Fetal Anomalies in Alberta: Potential Impact on Practitioners and the Health Care System

PsycEXTRA Dataset ◽

10.1037/e509012013-226 ◽

2004 ◽

Author(s):

Fu-Lin Wang ◽

Donald Schopflocher ◽

Stephan Gabos ◽

C. E. Demianczuk ◽

R. S. Chari ◽

...

Keyword(s):

Health Care ◽

Health Care System ◽

Fetal Anomalies ◽

Potential Impact ◽

Care System

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Ex vivo normothermic perfusion in heart transplantation: a review of the TransMedics® Organ Care System

Future Cardiology ◽

10.2217/fca-2021-0030 ◽

2021 ◽

Author(s):

Rebecca Pinnelas ◽

Jon A Kobashigawa

Keyword(s):

Viral Vector ◽

Ex Vivo ◽

Donation After Cardiac Death ◽

Machine Perfusion ◽

Donor Pool ◽

Complex Anatomy ◽

Normothermic Perfusion ◽

End Stage Heart Failure ◽

End Stage ◽

Care System

Cardiac transplantation is the gold standard for treatment for select patients with end-stage heart failure, yet donor supply is limited. Ex vivo machine perfusion is an emerging technology capable of safely preserving organs and expanding the viable donor pool. The TransMedics® Organ Care System™ is an investigational device which mimics physiologic conditions while maintaining the heart in a warm, beating state rather than cold storage. The use of Organ Care System allows increased opportunities for using organs from marginal donors, distant procurement sites, donation after cardiac death, and in recipients with complex anatomy. In the future, bioengineering technologies including use of mesenchymal stem cells, viral vector delivery of gene therapy, and alternate devices may further broaden the field of ex vivo machine perfusion.

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Dual kidney transplantation offers a safe and effective way to use kidneys from deceased donors older than 70 years

BMC Nephrology ◽

10.1186/s12882-019-1664-8 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 2

Author(s):

Kyo Won Lee ◽

Jae Berm Park ◽

So Ra Cha ◽

Seo Hee Lee ◽

Young Jae Chung ◽

...

Keyword(s):

Risk Factors ◽

Kidney Transplantation ◽

Serum Creatinine ◽

Survival Rates ◽

Donor Pool ◽

Expanded Criteria ◽

Deceased Donors ◽

Expanded Criteria Donors ◽

Single Kidney

Abstract Purpose Dual kidney transplantation (DKT) offers a way to extend the use of kidneys from expanded criteria donors (ECDs). Here, we compared the outcomes of DKT with those of single kidney transplantation from standard criteria donors (SCDs) and ECDs. Methods In 2014, we began performing DKT using both kidneys from deceased donors greater than 70 years of age with one of two risk factors: serum creatinine (sCr) level over 3.0 mg/dl or eGFR under 30 ml/min. By 2017, we had performed 15 DKTs. We compared the outcomes of the 15 DKT recipients with those of 124 patients who received a kidney from an SCD and 80 patients who received a kidney from an ECD. Results Compared with ECDs and SCDs, DKT donors were older, had a higher diabetes burden, and a higher sCr level (p < 0.01, < 0.01, and 0.03, respectively). DKT recipients were also older and had a higher diabetes burden than recipients of kidneys from ECDs and SCDs (p < 0.01, both). DKT recipients had a lower nadir sCr and shorter duration to nadir sCr than single ECD KT recipients (p < 0.01and 0.04, respectively). Conclusions The survival rates of DKT grafts were compatible with those of single KT grafts. Therefore, DKT may be considered a suitable an option to expand the donor pool.

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