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.