Reasons for donor heart offer refusal in the United States: Results from 14,132 transplant clinician surveys in the Donor Heart Study.

BACKGROUND

Despite a shortage of donors for heart transplant (HT) in the United States, most potential donor hearts are discarded. We evaluated the reasons why and their temporal and geographic variation using a US-wide survey of HT clinicians.

METHODS

The Donor Heart Study enrolled 4,333 adult potential heart donors in United States from 2015-2020. Separately by donor, each HT center that refused an offer for that donor was surveyed on their reason(s) for refusal. We measured the prevalence of 28 distinct donor-unrelated reasons for refusal and characterized their temporal and geographic variation.

RESULTS

Of 14,132 surveys collected-each representing a single declined donor offer-donor-specific, recipient, and mismatch issues were cited in 49.3%, 24.3%, and 38.0%, respectively. Among surveys citing only donor-specific issues, the most common were age, coronary artery disease, left ventricular (LV) systolic dysfunction, and LV hypertrophy; other noncardiac issue(s) (e.g., drug use) were the sole reason in 20.6% of surveys citing only donor-specific issues. Donor age as a reason for offer refusal became increasingly prevalent over time, despite no accompanying change in the prevalence of older (50+ year-old) donors. Reasons for offer refusal varied widely by region, in a manner unexplained by regional differences in objective donor characteristics.

CONCLUSIONS

Our findings highlight the subjective nature of donor heart assessment. Further scrutiny of non-evidence based reasons for refusal could reduce discard of viable donor hearts.