ARE EFFORTS AT EXPANDING THE DONOR POOL MISDIRECTED

Background: The number of patients potentially benefiting from heart t ransplantation far exceeds the number of hearts available. This has le d to an increasing interest in use of hearts from previously unaccepta ble donors. However, the long-term outcome of such hearts is largely u nknown. Research on other parts of the donor process may provide a gre ater number of additional hearts of high quality. Methods: Journal rev iews were conducted to identify proposed methods for use of previously unacceptable donor hearts, as well as research regarding the consent process. Data from the United Network for Organ Sharing were obtained to identify the reason consented heart referrals were not recovered. D ata from the Association of Organ Procurement Organizations were obtai ned for consent rates in the United States. Calculated estimates were made for the number of excess hearts potentially available by use of e xtended donor criteria versus increasing the consent rate. Results: Mo re than 40 articles proposing extended donor criteria were identified versus only 12 articles about consent. Of the 2199 consented heart ref errals not recovered in 1995, more than 1300 fit into a category amena ble to a proposed strategy for use of extended donors. If these strate gies were used aggressively (50% of the time), 701 additional hearts w ould have been available. Alternatively, if the consent rate were incr eased a comparable amount, 1260 excess hearts of high quality would ha ve been available. Conclusion: Although research into extended donor c riteria is probably justified, transplantation programs should direct research efforts into the consent process as a potential sourer of add itional hearts.