Highlights
- •Heart transplantation offers a cure for patients with advanced heart failure.
- •Innovations in organ procurement and allocation have expanded the donor pool.
- •The donor pool has also been expanded by donation after circulatory death donation and donors with hepatitis C.
- •Advances in donor–recipient matching and transplant care have improved outcomes.
Abstract
Advanced heart failure affects tens of thousands of people in the United States alone
with high morbidity and mortality. Cardiac transplantation offers the best treatment
strategy, but has been limited historically by donor availability. Recently, there
have been significant advances in organ allocation, donor–recipient matching, organ
preservation, and expansion of the donor pool. The current heart allocation system
prioritizes the sickest patients to minimize waitlist mortality. Advances in donor
organ selection, including predicted heart mass calculations and more sophisticated
antibody detection methods for allosensitized patients, offer more effective matching
of donors and recipients. Innovations in organ preservation such as with organ preservation
systems have widened the donor pool geographically. The use of donors with hepatitis
C is possible with the advent of effective direct-acting antiviral agents to cure
donor-transmitted hepatitis C. Finally, further expansion of the donor pool is occurring
with the use of higher risk donors with advanced age, medical comorbidities, and left
ventricular dysfunction and advances in donation after circulatory death. This review
provides an update on the new technologies and transplantation strategies that serve
to widen the donor pool and more effectively match donors and recipients so that heart
transplant candidates may derive the best outcomes from heart transplantation.
Graphical Abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: November 06, 2021
Accepted:
October 8,
2021
Received in revised form:
October 4,
2021
Received:
August 12,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
