METHODS
352 cardiac donor offers received between January 2012 and December 2014 were studied. Among those, 53 were excluded because of being pediatric donors offered to adults (37) or with incomplete data (16). The final cohort comprised 299 donor offers. Data were in part retrieved from the Ministry of Health National transplant registry and in part from each electronic donor’s medical record. Study was approved by the Institutional Review Board, which granted its use for research purposes with patient consent waived.
Acceptance for transplant or refusal was determined. In case of the latter, reasons for refusal were classified into medical and non-medical, in order to determine whether shortage of viable donors do have a limiting effect on heart transplant development in Mid-West of Brazil.
Data extracted from the Ministry of Health National transplant registry included a complete medical history related to brain death, past medical history, habits and full laboratory workup. Other assessments included echocardiography and/or coronary angiography, when performed and available.
In order to identify the donor profile in Brazil, and stratify donors into levels of severity, the donor scoring system, as proposed by Smits and associates9 , was used (Table 1). We used this particular scoring system because it is well validated in the literature. Donors were divided into high-risk when the scoring was ≥17 points or low-risk when scoring was <17 points. Donor scoring was correlated to donor acceptance for transplant. Of those transplanted, donor scoring was correlated to the presence of primary graft dysfunction and long-term survival. Confounding factors were taken into account on long-term survival, such as recipient age, primary diagnosis, urgency status at time of transplant, donor to recipient height ratio, weight and gender match, and ischemia time. The objective of using the donor scoring system is not to validate its use in Brazil, since there are exceptional differences in health care systems, particularly a validated donor management process with solid protocols in Europe. The primary aim of using the donor scoring system was to objectively characterize donor screening, and try to correlate it to our decision making during an organ offer, and the subsequent transplant outcomes.