INTRODUCTION
Heart transplantation is the gold standard treatment for patients with
end-stage heart failure. However, the last decade experienced a plateau
in the number of heart transplants1, despite some
promising results in North America lately2. As a
consequence, the number of heart failure patients who would benefit from
heart transplantation far exceeds the number of transplants performed.
Shortage of viable donors is certainly the most important limiting
factor, leading to higher death rates3 on the waiting
list in developed countries and jeopardizing heart transplantation as an
intention to treat principle. This shortage is magnified because many
hearts are discarded as a consequence of strict selection criteria and
concern for regulatory reprimand for less-than-optimal post-transplant
outcomes4. On the contrary, in countries with
well-established mechanical circulatory support programs, the bridge to
transplant strategy is usually associated with long waiting lists. Last
year, about half of transplants performed in developed
countries5 had a ventricular assist device placed at
the time of transplant, and only 28% get transplanted by the end of the
first year6. For that reason, donor allocation
policies need to be constantly revisited7 in order to
provide a fair access to this therapy.
Economic, religious, and cultural differences amongst countries and
regions in the same country prevail and they account for very different
realities that explain the unequal access to heart transplantation.
Lastly, and not least important, intensive care related to donor is
probably less developed8, which determines a very low
rate of donor acceptance among the potential donor pool. Reasons for
refusal vary considerably according to the individual transplant center,
including medical and non-medical issues. There is no standardized
approach to donor selection despite proposals to liberalize acceptance
criteria. Available donor risk scoring system9 may
help in the decision-making process, eventually expanding donor pool to
marginal donors.
The objectives of this study are 1) to determine whether the shortage of
viable donors in Mid-West of Brazil limits heart transplantation; 2) to
correlate donor risk scoring to donor acceptance in order to determine
the influence of donor profile on the decision to transplant; 3) to
delineate reasons for donor refusal and 4) to correlate donor risk
scoring with post-transplant primary graft dysfunction and long-term
survival.