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Heart transplantation – call for more donor hearts

Increasing numbers of people in the USA are developing heart failure, while heart transplant waiting lists are becoming longer, a new study published in the American Journal of Transplantation reveals.1

The study examined national trends in donor heart acceptance for transplantation by analysing data from the Organ Procurement and Transplantation Network for all potential adult cardiac organ donors between 1995 and 2010. There was a significant decrease in donor heart acceptance from 44% in 1995 to 29% in 2006, and subsequent increase to 32% in 2010. Older donor age, female sex, and medical conditions predicted non-acceptance of hearts from donors. Donor age and medical conditions increased over time, with a concomitant decrease in acceptance of hearts from donors with undesirable characteristics.

The analysis also demonstrated regional variability in donor heart utilisation across the United States, showing that some regions have been using a relatively higher proportion of donor hearts than others. This suggests that donor heart acceptance practices are not standardised and indicates a need for clinical guidelines for donor heart acceptance, as well as more intense efforts to increase the use of donor hearts in areas with relatively low utilisation rates.

The investigators noted that there is a very high level of scrutiny of transplant centers by government agencies, which may have the unintended consequence of making transplant centers more “risk averse” and therefore less likely to use marginal donor hearts for transplantation.

The Children’s Heart Federation has launched a campaign to highlight the need for more heart donors for children and young people. The consent rate for organ donation has remained static, while the number of children with congenital heart conditions is growing each year, according to a statement.

The Federation recently held a parliamentary reception to raise awareness of the issue. Speakers at the event included: Dr Clive Lewis, who supports the UK’s largest heart transplant programme; the parents of Freya, who received a heart transplant when she was 5 years old; and Scott Rutherford from Newcastle, who received a heart transplant at 14 years old.

Anne Keatley Clarke (CEO of Children’s Heart Federation)

Anne Keatley Clarke (CEO of Children’s Heart Federation)

At the reception Nick and Claire Bingham, the parents of Freya, said: “Our world turned upside down when we received the news that Freya’s heart was failing. It was a living nightmare.  We arrived at the hospital in the middle of the night and Freya was put on a Berlin Heart Machine for 63 agonising days.  Thankfully we received a heart but without the donor Freya would not be alive today.  All our family are on the register now.”

Toby Perkins MP, who hosted the event, said: “After meeting the Bingham family, and hearing how important a transplant was for their daughter, I was determined to do what I can to raise awareness about this important issue. I hope this event will contribute to this campaign and I’m delighted that MPs and ministers will get to hear first-hand from a family on this important subject.”

Anne Keatley Clarke, Chief Executive of Children’s Heart Federation, said: “The Children’s Heart Federation wants to give heart children the best chance of life.  We’ve come a long way with medical advancements for these children over the years – we now need to look to their future.”

Speaking to BJC Arrhythmia Watch, Ms Clarke said: “The Children’s Heart Federation, clinicians and  patients need to join forces to create an environment where the vast majority of  people in the UK are prepared to donate their organs when and if they can. We want families to be proud to agree to donation when their relative’s wish is unknown”

“With increasing demand and the continued shortage of donor hearts, it is more important than ever that we also work together to produce and update structured guidelines and standards on heart transplantation to ensure equity of treatment for patients with congenital heart disease,” Ms Clarke added.

References

1. Khush KK, Zaroff JG, Nguyen J, Menza R, Goldstein BA. National decline in donor heart utilization with regional variability: 1995–2010.” Am J Trans 2015;15:642–9. http://dx.doi.org/10.1111/ajt.13055

Published on: February 25, 2015

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