Pediatric marginal donor hearts: Trends in US national use, 2005-2014

Adam K. Morrison; Charitha Gowda; Dmitry Tumin; Christina M. Phelps; Don Hayes; Joseph Tobias; Robert J. Gajarski; Deipanjan Nandi

doi:10.1111/petr.13216

Pediatric marginal donor hearts: Trends in US national use, 2005-2014

Adam K. Morrison^*, Charitha Gowda, Dmitry Tumin, Christina M. Phelps, Don Hayes, Joseph Tobias, Robert J. Gajarski, Deipanjan Nandi

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

33 Scopus citations

Abstract

Pediatric patients awaiting heart transplant face high mortality rates due to donor organ shortages, including non-use of marginal donor hearts. We examined national trends in pediatric marginal donor heart use over time. UNOS data were queried for heart donors <18 years from 2005 to 2014. The proportion of donor hearts considered marginal was determined using previously cited marginal characteristics: left ventricular ejection fraction (LVEF) <50%, use of ≥2 inotropes, cerebrovascular death, CDC high-risk status, and eGFR < 30 mL/min/1.73 m². Disposition of donor hearts was determined and stratified by marginal donor status. Of 6778 pediatric hearts offered from 2005 to 2014, 2373 (35.0%) were considered marginal. Non-use of marginal donor hearts was significantly higher than that of donor hearts without any marginal characteristics (59.5% vs 20.3%, P <.001). In particular, LVEF < 50% and donor inotropes were associated with high rates of organ non-use among pediatric donors. Yet, non-use of marginal donor organs decreased from 67% to 48% from 2005 to 2014 (P <.001). Although the proportion of pediatric donor hearts used for pediatric patients has increased, more than half of donor hearts are declined for use in pediatric recipients due, in part, to perceived marginal status.

Original language	English (US)
Article number	e13216
Journal	Pediatric transplantation
Volume	22
Issue number	5
DOIs	https://doi.org/10.1111/petr.13216
State	Published - Aug 2018

Funding

The data reported here have been supplied by the UNOS as the contractor for the OPTN. The interpretation and reporting of these data are the responsibility of the authors and in no way, should be seen as an official policy of or interpretation by the OPTN or the US Government. Based on OPTN data as of June 9, 2017, this work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

Keywords

cardiac
donor
heart
marginal
pediatric
transplant

ASJC Scopus subject areas

Transplantation
Pediatrics, Perinatology, and Child Health

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10.1111/petr.13216

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title = "Pediatric marginal donor hearts: Trends in US national use, 2005-2014",

abstract = "Pediatric patients awaiting heart transplant face high mortality rates due to donor organ shortages, including non-use of marginal donor hearts. We examined national trends in pediatric marginal donor heart use over time. UNOS data were queried for heart donors <18 years from 2005 to 2014. The proportion of donor hearts considered marginal was determined using previously cited marginal characteristics: left ventricular ejection fraction (LVEF) <50%, use of ≥2 inotropes, cerebrovascular death, CDC high-risk status, and eGFR < 30 mL/min/1.73 m2. Disposition of donor hearts was determined and stratified by marginal donor status. Of 6778 pediatric hearts offered from 2005 to 2014, 2373 (35.0%) were considered marginal. Non-use of marginal donor hearts was significantly higher than that of donor hearts without any marginal characteristics (59.5% vs 20.3%, P <.001). In particular, LVEF < 50% and donor inotropes were associated with high rates of organ non-use among pediatric donors. Yet, non-use of marginal donor organs decreased from 67% to 48% from 2005 to 2014 (P <.001). Although the proportion of pediatric donor hearts used for pediatric patients has increased, more than half of donor hearts are declined for use in pediatric recipients due, in part, to perceived marginal status.",

keywords = "cardiac, donor, heart, marginal, pediatric, transplant",

author = "Morrison, {Adam K.} and Charitha Gowda and Dmitry Tumin and Phelps, {Christina M.} and Don Hayes and Joseph Tobias and Gajarski, {Robert J.} and Deipanjan Nandi",

note = "Funding Information: The data reported here have been supplied by the UNOS as the contractor for the OPTN. The interpretation and reporting of these data are the responsibility of the authors and in no way, should be seen as an official policy of or interpretation by the OPTN or the US Government. Based on OPTN data as of June 9, 2017, this work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. Publisher Copyright: {\textcopyright} 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd",

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T2 - Trends in US national use, 2005-2014

AU - Morrison, Adam K.

AU - Gowda, Charitha

AU - Tumin, Dmitry

AU - Phelps, Christina M.

AU - Hayes, Don

AU - Tobias, Joseph

AU - Gajarski, Robert J.

AU - Nandi, Deipanjan

N1 - Funding Information: The data reported here have been supplied by the UNOS as the contractor for the OPTN. The interpretation and reporting of these data are the responsibility of the authors and in no way, should be seen as an official policy of or interpretation by the OPTN or the US Government. Based on OPTN data as of June 9, 2017, this work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. Publisher Copyright: © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

PY - 2018/8

Y1 - 2018/8

N2 - Pediatric patients awaiting heart transplant face high mortality rates due to donor organ shortages, including non-use of marginal donor hearts. We examined national trends in pediatric marginal donor heart use over time. UNOS data were queried for heart donors <18 years from 2005 to 2014. The proportion of donor hearts considered marginal was determined using previously cited marginal characteristics: left ventricular ejection fraction (LVEF) <50%, use of ≥2 inotropes, cerebrovascular death, CDC high-risk status, and eGFR < 30 mL/min/1.73 m2. Disposition of donor hearts was determined and stratified by marginal donor status. Of 6778 pediatric hearts offered from 2005 to 2014, 2373 (35.0%) were considered marginal. Non-use of marginal donor hearts was significantly higher than that of donor hearts without any marginal characteristics (59.5% vs 20.3%, P <.001). In particular, LVEF < 50% and donor inotropes were associated with high rates of organ non-use among pediatric donors. Yet, non-use of marginal donor organs decreased from 67% to 48% from 2005 to 2014 (P <.001). Although the proportion of pediatric donor hearts used for pediatric patients has increased, more than half of donor hearts are declined for use in pediatric recipients due, in part, to perceived marginal status.

AB - Pediatric patients awaiting heart transplant face high mortality rates due to donor organ shortages, including non-use of marginal donor hearts. We examined national trends in pediatric marginal donor heart use over time. UNOS data were queried for heart donors <18 years from 2005 to 2014. The proportion of donor hearts considered marginal was determined using previously cited marginal characteristics: left ventricular ejection fraction (LVEF) <50%, use of ≥2 inotropes, cerebrovascular death, CDC high-risk status, and eGFR < 30 mL/min/1.73 m2. Disposition of donor hearts was determined and stratified by marginal donor status. Of 6778 pediatric hearts offered from 2005 to 2014, 2373 (35.0%) were considered marginal. Non-use of marginal donor hearts was significantly higher than that of donor hearts without any marginal characteristics (59.5% vs 20.3%, P <.001). In particular, LVEF < 50% and donor inotropes were associated with high rates of organ non-use among pediatric donors. Yet, non-use of marginal donor organs decreased from 67% to 48% from 2005 to 2014 (P <.001). Although the proportion of pediatric donor hearts used for pediatric patients has increased, more than half of donor hearts are declined for use in pediatric recipients due, in part, to perceived marginal status.

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SN - 1397-3142

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JF - Pediatric transplantation

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ER -

Pediatric marginal donor hearts: Trends in US national use, 2005-2014

Abstract

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