Extended donor criteria in heart transplantation: 4-year results of the experience with the Organ Care system

Objectives: The Organ Care system (OCS) is a portable organ perfusion and monitoring system intended to maintain donor hearts in a near-physiological and functioning state ex-vivo for transplantation.

We report the midterm results of our current experience with the OCS in cases of extended organ transportation time and marginal donor hearts.

Methods: Between January 2009 and September 2010 21 donor hearts have been maintained on OCS. Six hearts were offered primarily, six as competitive rescue allocation and nine hearts were previously declined by 1-7 (median 4) other centers. Three hearts came from countries outside the Eurotransplant area. Donor age ranged from 17 to 70 (median 49) years. 12 recipients were bridged to transplantation by mechanical circulatory support (LVAD n = 7, BVAD n = 3, TAH n = 2). Early graft function was assessed by hemodynamics and daily echocardiography. Protocol coronary angiography was performed annually.

Results: The median time the heart spent ex-vivo was 388 minutes (range: 254- 502) of which 68 (range: 55-88) minutes was median total cold ischemia time and 320 (range: 199-414) minutes represented oxygenated warm blood perfusion. All hearts were successfully transplanted, with excellent graft function. Two patients died for cardiac related reasons four and 249 days after transplantation, resulting in a freedom from cardiac related death of 95% at 30 days and 6 months and 87% at one year and four years, respectively. None of the follow up coronary angiographies revealed evidence for post transplant vasculopathy.

Conclusions: The OCS keeps hearts from an extended donor pool and with extended organ transportation time in healthy condition, resulting in excellent primary and mid-term graft function. The system may have the potential to improve donor organ availability and transplantation outcomes.