Functional assessment and management of heart donors: a rationale for characterization and a guide to therapy.
BACKGROUND: Traditional methods for the functional evaluation of a donor heart have relied on superficial hemodynamic data and visual inspection of the action of the heart at sternotomy. The International Registry has continued to report significant mortality for heart transplant recipients from primary graft dysfunction that may be due to donor management, donor organ selection, organ preservation, or recipient factors. The literature reports the loss of at least 25% of potential donors because of the provision of inadequate physiologic support. METHODS AND RESULTS: We have now spent several years in establishing and refining a strategy for optimizing donor management, which has resulted in the safe expansion of our donor pool by approximately 30%. Central to this management regimen has been the use of comprehensive perioperative invasive monitoring used by a cardiac anesthetist who takes responsibility for donor management during the retrieval operation. CONCLUSION: This article outlines the technique which has evolved for the functional evaluation of a donor heart, which is now used in our institution as a guide to management and as a basis for decision making regarding organ suitability.