SUCCESSFUL USE OF UNDERSIZED DONORS FOR ORTHOTOPIC HEART-TRANSPLANTATION - WITH A CAVEAT

Accepted clinical practice has been to require body weights to be with in 20% as a criterion for matching donor to recipient for cardiac tran splantation. From November 1989 through September 1993 we began accept ing larger differences in body weight between donor and recipient with 80 orthotopic heart transplants performed. Twenty-eight of these tran splants used undersized donors (donor-to-recipient body weight ratio [ DRBW] of 0.6 to 0.8) with the remaining donors being either size match ed (DRBW = 0.8 to 1.0) or oversized (DRBW > 1.0). Thirty-three of the 80 transplant recipients (41%) were classified preoperatively as Unite d Network for Organ Sharing (UNOS) status I and the remaining patients were classified as UNOS status II. Hospital survival for status I rec ipients was 9 of 14 (64%) for undersized donors, 7 of 8 (87.5%) for si zed-matched donors, and 11 of 11 (100%) for oversized donors (p < 0.05 ). Hospital survival for status II recipients was 12 of 14 (85.7%) for undersized donors, 24 of 24 (100%) for sized-matched donors, and 8 of 9 (88.8%) for oversized donors. Our data support the continued use of hearts from undersized donors in status II recipients. The use of hea rts from undersized donors in status I recipients is associated with i ncreased mortality compared with size-matched donors and must be under taken with caution.