Hospital heart transplant centers that adopt a scoring method can greatly increase the chance recipients will be alive one year later and thereby more efficiently use scarce donor hearts, say cardiac surgery researchers at Johns Hopkins Medical Institutions.
"If you want to enhance post transplant survival, you'd shift organs from some of the people we've identified with multiple risk factors for poor outcomes to patients with a better chance," explained Ashish Shah, MD, Surgical Director of Johns Hopkins' lung transplant program and one of the study's authors.
"If you think about this as a limited resource, you have to be careful with offering transplants when we don't have enough hearts to go around," Shah said in a telephone interview. In the published paper, the authors say they "surmise" that their index "could serve to drive clinical decisions regarding allocation of marginal organs and may prove especially useful in an era of increasing ventricular assist device (VAD) utilization."
Current practice evaluates eligibility based on how sick a patient is and how long they've been on a waiting list, and other aspects of a patient's condition that are educated guesses. The new tool gives transplant specialists more scientific basis for choosing their candidates.
The researchers evaluated 21,378 patients who received a donor heart between 1997 and 2008 in the United Network for Organ Sharing database and tracked them to December of 2010. They then scored numerous patient variables and conditions that might have influenced their survival and formatted them in a 50-point scoring system that allocated points to each factor.