Conclusions
In this study of 85,505 donor heart offers across the United States to 133 different centers, 15,264 (17.9%) resulted in acceptance for OHT. Centers range considerably with regards to donor heart acceptance rates. In centers with higher acceptance rates, there was a higher utilization of ECDs, yet one- and five-year posttransplant survival were comparable to less aggressive transplanting centers. Additionally, of the five ECD factors, only donor age >40 years was associated with higher risk for posttransplant mortality. This data suggests that transplanting centers, regardless of aggressiveness and clinical volume, can safely utilize ECDs with the other four risk factors (LVEF <60%, >500-mile distance, >50 previous offers, and HIV, HCV, or HBV positive) and achieve comparable posttransplant outcomes. Expansion of these donor criteria may help alleviate the relative organ shortage in the wake of an increasing heart failure population. Furthermore, a more in-depth understanding of donor acceptance practices in more aggressive centers with possible education and transfer of these practices to less aggressive centers may yield more OHTs nationally without an adverse impact on outcomes.
Acknowledgements
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