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

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


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 languageEnglish (US)
Article numbere13216
JournalPediatric transplantation
Issue number5
StatePublished - Aug 2018


  • cardiac
  • donor
  • heart
  • marginal
  • pediatric
  • transplant

ASJC Scopus subject areas

  • Transplantation
  • Pediatrics, Perinatology, and Child Health


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