DOMINO HEART-TRANSPLANTATION - THE PAPWORTH EXPERIENCE

The use of donor hearts from heart-lung recipients, the so-called domi no procedure, began at Papworth Hospital in November 1988. Between the n and September 1992, 198 heart transplantations and 86 heart-lung tra nsplantations were performed. Fifty-three heart-lung recipients donate d their hearts for use in the domino procedure. Thirty-two domino hear ts were transplanted at Papworth and 21 were exported to other centers . Institution of the domino procedure allowed us to perform 19% more h eart transplantations (166 to 198) than would have been done had the p rocedure not been used. The ischemic time was significantly shorter fo r the domino hearts compared with organs from brain dead donors (134 m inutes versus 191 minutes; p < 0.001). No difference was found in the 3-month (84% versus 83%) or 1-year (74% versus 76%) survival between d omino and nondomino recipients. Other potential advantages of the domi no procedure include detailed pretransplantation evaluation of the hea rt in live donors and the potential for human leukocyte antigen matchi ng. Additionally many heart-lung recipients have elevated pulmonary ar tery pressures and a ''conditioned'', hypertrophied right ventricle. T he use of such hearts for heart transplantation has theoretic appeal f or patients with elevated pulmonary vascular resistance.