Accepting a heart that has an increased risk of potentially transmitting disease offers a higher one-year survival rate for candidates on the transplant list over waiting for an organ with less risk, according to a research letter published Oct. 29 in the Journal of the American College of Cardiology.

Increased risk donors make up a growing number in the donor pool for organs, offering a potential strategy to reduce waitlist mortality for patients awaiting transplant. For many of these patients, the benefit of proceeding with transplantation sooner may outweigh the low risk of disease transmission associated with these donors. Increased risk donors are defined as organ donors who carry an increased risk for inadvertent disease transmission to the transplant recipient, including HIV, Hepatitis B Virus and Hepatitis C Virus. In 2015, increased risk donors represented 19.5 percent of the donor pool.

Michael S. Mulvihill, MD, et al., performed a retrospective registry analysis to examine the impact of declining an increased risk donor heart for heart transplant candidates compared to candidates who accepted the offer. Using United Network of Organ Sharing data, a total of 2,602 increased risk donor hearts were offered to 10,851 heart transplant candidates from 2007 to 2017. To measure competing outcomes, researchers followed candidates who declined an increased donor risk heart until eventual heart transplant (increased donor risk or non-increased donor risk), death or decompensation precluding heart transplant, or ongoing time on the transplant waitlist. These candidates were compared with candidates who accepted an increased risk donor heart to determine the survival benefit associated with acceptance of the increased risk donor organ.

Of the patients who declined the initial increased risk donor offer, 58 percent underwent a non-increased risk donor heart transplant, 12.4 percent underwent a later increased risk donor heart transplant, 7.9 percent were removed from the waitlist due to death or decompensation, and 21.1 percent were still waiting for a heart transplant one year after the initial offer. Patients who accepted the initial increased risk donor offer had 92.1 percent survival rates after one year compared to 83.1 percent for those who declined. Researchers found this benefit persisted 5 years post-offer.

“Increased risk donor organs offer an opportunity to decrease waitlist mortality for patients awaiting heart transplant,” Mulvihill said. “It’s worth making sure candidates, clinicians and listing centers discuss the risks and benefits of increased risk donor offers for these patients.”

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant

Keywords: Survival Rate, Transplantation, Retrospective Studies, Hepatitis B virus, Hepacivirus, Tissue Donors, Heart Transplantation, Heart Failure, Registries, Risk Assessment, HIV Infections

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