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CLINICAL STUDY: HEART TRANSPLANT

Angiography of potential cardiac donors

Paul J. Hauptman, MD^*, Kevin J. O’Connor, MS, Robert E. Wolf, MS and Barbara J. McNeil, MD, PhD

^* Department of Medicine, Division of Cardiology, St. Louis University School of Medicine, St. Louis, Missouri, USA
The New England Organ Bank, Newton, Massachusetts, USA
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA

Manuscript received August 9, 2000; revised manuscript received November 14, 2000, accepted December 15, 2000.

Reprint requests and correspondence: Dr. Paul J. Hauptman, Division of Cardiology, St. Louis University Health Sciences Center, 3635 Vista Avenue at Grand Boulevard, St. Louis, Missouri 63110
Hauptmpj{at}slu.edu

OBJECTIVES

This retrospective review of organ donor records was designed to evaluate the practice of donor angiography in one organ procurement organization and determine the outcomes of angiography and its impact on the timing of the organ donation process.

BACKGROUND

Concerns about transmission of atherosclerosis from donor to recipient have been heightened by the increasing prevalence of older donors. Guidelines that advocate the use of angiography in specific settings have been published, but no formal large-scale review has been performed.

METHODS

For the period January 1993 through June 1997, we reviewed all New England Organ Bank records of donors between the ages of 40 and 65 including any from whom at least one solid organ was procured. Data abstracted included the presence of risk factors, timing of the evaluation process and angiographic findings.

RESULTS

Coronary angiography was performed in 119 donors aged 40 and older; 64.7% of these hearts were transplanted. Thirty-eight hearts were transplanted from donors not subjected to angiography and outcomes were poorer compared with donors who underwent angiography. Advanced donor age was the only significant predictor of coronary artery disease. The duration of the procurement process was not prolonged by the performance of angiography.

CONCLUSIONS

Donor coronary angiography does not complicate the donation process. Older donor age is the most powerful predictor of coronary artery disease and may explain prior observations of poorer outcome with older donor hearts. These factors should be considered when angiography is performed as part of the heart donor evaluation.

Abbreviations and Acronyms   ACC = American College of Cardiology   CAD = coronary artery disease   CI = confidence interval   CPR = cardiopulmonary resuscitation   NA = donor angiography not performed   NH = donor heart not transplanted   YA = donor angiography performed   YH = donor heart transplanted

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