EXTENDED CRITERIA FOR CARDIAC ALLOGRAFT DONORS - A CONSENSUS STUDY

Background and Methods: To achieve a consensus regarding extending the current criteria for referring potential cardiac allograft donor, we sent a detailed questionnaire to all heart transplant surgeons in the United Kingdom. Results: Replies representing the opinion of 16 heart transplant surgeons (88% response rate) suggest that the majority beli eve that donor age could be extended up to 55 years even in the absenc e of a coronary angiogram or echocardiogram. Family history of ischemi c heart disease, history of hyperlipidemia or smoking, and brain death caused by paracetamole or barbiturates overdose were not considered p rohibitive to cardiac allograft donation. Similarly, chest trauma, pro longed mechanical ventilation, pre-referral cardiac arrest or hypotens ion for any length of time, and nonspecific ST-segment elevation were not considered to be contraindications. By contrast, significant Q wav es in a recent electrocardiogram, the presence of hepatitis C antibodi es, pulmonary capillary wedge pressure more than 20 mm Hg, and depende ncy on multiple inotropic support were considered definite exclusion c riteria. Donor hormonal resuscitation (T3-cocktail), insertion of a Sw an-Ganz catheter, and direct measurement of intracavitary pressure at the time of retrieval were considered unnecessary by more than 80% of respondents. There was no consensus of opinion regarding the use of do nors above the age of 55 years, brain death caused by carbon monoxide poisoning, history of diabetes mellitus, alcohol or drug abuse, system ic infections, electrocardiographic evidence of left ventricular hyper trophy, or the maximum dose of inotropic support required to maintain satisfactory hemodynamics. Conclusions: The number of potential cardia c allograft donors can be increased by extending the donor age to 55 y ears. Brain death caused by Paracetamole and barbiturate overdose may not prohibit organ donation.