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Abstract

Purpose of Review
There are several aspects of donor selection for heart transplantation that are particularly challenging. Information about the donor is often limited and relayed through a review of selected chart snippets and tests. The donor heart must work immediately unlike kidney transplantation where delayed function is common and not life-threatening. This review focuses on recent findings in the literature which are distilled for the transplant clinician to be eminently practical to advise teams as they consider which donor factors are important in individual situations.

Recent Findings
Left ventricular dysfunction has many causes and particularly in younger donors may resolve with time. Such donors can be utilized with excellent results. Donor age is still a critically important risk factor for outcome post-transplant though it is additive with other factors such as left ventricular hypertrophy and anticipated ischemic time. Donor size is another important factor and recent work suggests that calculation of predicted heart mass is superior to simple weight, height, and gender in reaching a decision about donor sizing. Recent work suggests that even donors with non-critical coronary lesions (50% or less) may be utilized with similar outcomes, including a similar incidence of progression of vasculopathy. Diabetes appears to be a manageable comorbidity particularly with careful screening. With the increase in drug-related deaths, a recent study looking at more than 23,000 accepted donors found no difference in long-term survival with multiple drugs in the toxicology screen of the donor which may allow increased use of such donors. Finally, we review the details of donation after circulatory determination of death (DCD). Currently, this is confined to certain specialized centers but this is anticipated to become more common worldwide and enhance the number of transplants over time.

Summary
Current evidence is reviewed and summarized to allow the busy transplant clinician to be up to date on the latest information regarding large and smaller important studies in this field. It is hoped that this review helps teams maximize their use of appropriate donors.