Organizational, medical and epidemiological prerequisites for reviewing donor criteria in heart transplantation

Abstract

Organ donation and transplantation in Moscow have witnessed changes in the last decade. These changes have led not only to quantitative growth in the number of effective donors but also to fundamentally new (for Russian medical practice) characteristics of the donor pool. As a result, the selection criteria for organ donors have undergone some radical revisions. Objective: to analyze the medical and epidemiological characteristics of the pool of effective heart donors and assess their impact on selection of heart transplants. Materials and methods. In our study, we used the medical and epidemiological data of 650 brain-dead donors whose organs were procured from January 1, 2012 to December 31, 2017. Results. During the study period, the number of effective heart donors in Moscow increased from 4.4 (2012) to 11.2 (2017) per million population per year. The medical and epidemiological characteristics of the total pool of donors and the pool of heart donors underwent major changes. Among effective heart donors, there was a dynamic increase in the average age from 38.4 to 47 years, predominance of a proportion of donors with stroke 38.2 (2012) vs 83.2 (2017) and, accordingly, an increase in the frequency of such comorbid conditions, as hypertension and diabetes. Conclusion. The results presented in the study indicate a growing practice of working with expanded criteria donors. This practice is most effectively developed in the field of heart transplantation than in transplantation of other extrarenal organs. Undoubtedly, the experience under study is unique and relevant not only for the Russian Federation, but also for the world of transplantology, as it allows to provide vital assistance to patients with end-stage heart failure within a reasonable timeframe.