Some rejected donor hearts are found to be transplant-viable
Despite a dire shortage of organ donors, transplant teams turn down about one in four hearts from brain-dead donors because their hearts appear to pump poorly.
If the organ is given time to recover, however, as many as half of these hearts may be suitable for transplant, according to new research from the University of Washington's Harborview Injury Prevention and Research Center (HIPRC).
Poor heart muscle function after severe brain injury is common, said study co-author Dr. Vijay Krishnamoorthy, UW acting assistant professor of anesthesiology. This poor response is attributed to a flood of neurotransmitters, inflammatory chemicals and hormones released by the damaged brain that “stun” the heart.
Such “cardiac stunning” is seen even in children and young adults with severe brain injury who have no prior evidence of heart disease, he said.
Previous research conducted at the center has shown that some stunned hearts recover with time. In the new study, the UW researchers wanted to determine how common heart stunning was in patients who have suffered brain death and how many these stunned hearts recover.
To do this, they reviewed records compiled by the Life Center Northwest, which procures organs for transplantation in Alaska, Montana, northern Idaho and Washington. They identified 246 potential brain-dead donors who had at least one echocardiogram to assess their hearts’ function.
Echocardiograms, images of the heart created with sound waves, can detect abnormal heart-wall motion and how well the heart works as a pump. Hearts that appear to pump blood inadequately or have significant wall-motion abnormalities are often considered unsuitable for transplant.
The UW researchers found that cardiac dysfunction was common, affecting 70 of the 246 patients, or about one in three. This was in line with previous studies' findings. But in 15 of the 29 patients who had cardiac dysfunction and more than one echocardiogram, heart function recovered enough to qualify the heart for transplantation.
“This is a small study,” Krishnamoorthy says, “but it suggests that we shouldn’t decide whether to use a heart on the basis of just one early evaluation, particularly in young people who are unlikely to have heart disease. Instead, if the initial echocardiogram detects heart dysfunction, we should maintain these patients with optimal supportive care and check again in one or two days. In many cases, the heart will have recovered and be suitable for transplantation.”
The study appears in Neurocritical Care; see the paper for the list of other authors. This study was supported in part by an National Research Service Awards T32 (T32 GM086270) training grant from the U.S. National Institutes of Health.