High-Risk Donors, Marginal Donors, and Risk Assessment

This chapter aims to provide an overview of the evidence supporting the use of “high-risk” and “marginal” donor hearts for transplantation and provides a framework for risk assessment that could be used by transplant physicians to help inform donor selection in order to improve donor utilization. The terminology “high-risk” or “increased-risk” donors, according to the US Public Health Service, refers to donor characteristics that place the recipient at an increased risk of disease transmission with organ transplantation. In early studies, use of hepatitis C virus-positive donors in heart transplantation was associated with reduced post-transplant survival and increased rates of liver failure and coronary allograft vasculopathy. While donor heart selection is a critical part of the heart allocation process, risk for primary graft failure after transplant is also driven by recipient and procedural factors in addition to donor characteristics.