Background: The number of patients potentially benefiting from heart transplantation far exceeds the number of hearts available. This has led to an increasing interest in use of hearts from previously unacceptable donors. However, the long-term outcome of such hearts is largely unknown. Research on other parts of the donor process may provide a greater number of additional hearts of high quality.
Methods: Journal reviews were conducted to identify proposed methods for use of previously unacceptable donor hearts, as well as research regarding the consent process. Data from the United Network for Organ Sharing were obtained to identify the reason consented heart referrals were not recovered. Data from the Association of Organ Procurement Organizations were obtained for consent rates in the United States. Calculated estimates were made for the number of excess hearts potentially available by use of extended donor criteria versus increasing the consent rate.
Results: More than 40 articles proposing extended donor criteria were identified versus only 12 articles about consent. Of the 2199 consented heart referrals not recovered in 1995, more than 1300 fit into a category amenable to a proposed strategy for use of extended donors. If these strategies were used aggressively (50% of the time), 701 additional hearts would have been available. Alternatively, if the consent rate were increased a comparable amount, 1260 excess hearts of high quality would have been available.
Conclusion: Although research into extended donor criteria is probably justified, transplantation programs should direct research efforts into the consent process as a potential source of additional hearts.