The Number of Refusals for Donor Organ Quality Does Not Impact Heart Transplant Outcomes in Children

Abstract

Background: Waitlist mortality is more than 12% for pediatric heart transplantation, with strikingly high rates of organ refusal, many of which are due to donor quality. However, some centers use these organs despite refusals by other centers for donor quality. We hypothesize that the number of refusals for donor quality (RDQ) does not affect pediatric heart transplantation outcomes.

Methods: Pediatric heart transplants from 2000 to 2015 were identified using the United Network for Organ Sharing database and were matched against the potential transplant recipients dataset with donor refusal codes. Refusals for donor quality were counted for each organ. The population was divided into two groups: RDQ-low (0 to 3 RDQs, n = 3,404) and RDQ-high (>3 RDQs, n = 1,585). Posttransplant outcomes of both cohorts were analyzed.

Results: Of 4,989 pediatric heart transplants, 75% (n = 3,770) had 1 or more RDQ (median 3 RDQ; interquartile range, 1 to 7). The RDQ-lower group (0 to 3 RDQs) and the RDQ-higher group (>3 RDQ) had similar posttransplant survival (p = 0.41) and freedom from retransplantation (p = 0.37). Both groups had similar posttransplant survival even for high-risk recipient cohorts: adolescents (p = 0.06), congenital heart disease (p = 0.87), retransplantation (p = 0.47), extracorporeal membrane oxygenation (p = 0.61), mechanical ventilation (p = 0.24), and poor renal function at transplant (p = 0.46). In addition, recipient subgroups who had donors with increasing number of RDQ (>6, >9, >12, and >15 RDQ) also had similar posttransplant survival compared with the RDQ-low group (p = 0.63, p = 0.62, p = 0.92, and p = 0.50, respectively).

Conclusions: The outcome of pediatric heart transplantation is not affected by the number of RDQ, even for high-risk recipients. The use and interpretation of donor quality refusal code should be considered carefully while selecting or refusing donors in this era of supply and demand mismatch.