Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

New strategies to expand the donor pool: are they misguided?

Nature Clinical Practice Cardiovascular Medicine volume 1, pages 2–3 (2004)Cite this article

It has become self-evident that the overall success of heart transplantation is limited by the critical shortage of donor organs. Estimates by the United Network for Organ Sharing demonstrate that in the US alone, the overall number of all solid-organ donors has increased annually over the past decade by only 1–5% per year; the number of heart donors has actually steadily declined since its peak of 2,525 in 1994.1 This pattern has been seen worldwide, according to data released from the International Society of Heart and Lung Transplantation. During this same time-frame, the widespread use of ventricular assist devices as a bridge to transplantation, the increasing availability of transplantation at new centers worldwide and improvements in immunosuppressive therapies have contributed to an ever-growing need. Furthermore, despite improved management and stabilization of recipients on the waiting list, the current waiting list mortality has remained at 16–18%, with 42% of patients waiting more than 2 years.1

Since the early description of the ideal donor by Griepp et al.2 in 1971, the criteria by which donors are accepted, and the characteristics that determine a high-risk donor, have changed substantially. Each year, several strategies are promoted in an effort to extend the donor criteria and thereby expand the donor pool. Ultimately, however, the question of so-called donor risk inevitably represents a larger intellectual balance of both donor and recipient risk characteristics. Thus, the number of and extent to which donor criteria are waived in a given circumstance often more closely represents the acuity of the recipient's condition than the actual utility, or risk, of the donor.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. United Network for Organ Sharing, OPTN/SRTR 2003 Annual Report www.unos.org (accessed 7 September 2004)

  2. Griepp RB et al. (1971) The cardiac donor. Surg Gynecol Obstet 133: 792–798

    CAS  PubMed  Google Scholar 

  3. Chan BBK et al. (1991) Weight is not an accurate criterion for adult cardiac transplant size matching. Ann Thorac Surg 52: 1230–1236

    Article  CAS  Google Scholar 

  4. Drummond-Webb JJ (2004) Expanding the donor pool: use of a donor heart having undergone recent cardiac surgery. J Heart Lung Transplant 23: 639–640

    Article  Google Scholar 

  5. Siminoff LA et al. (2001) Factors influencing families' consent for donation of solid organs for transplantation. JAMA 286: 71–77

    Article  CAS  Google Scholar 

  6. Sheehy E et al. (2003) Estimating the number of potential organ donors in the United States. N Engl J Med 349: 667–674

    Article  Google Scholar 

  7. Miller M (1987) A proposed solution to the present organ donation crisis based on a hard look at the past. Circulation 75: 20–28

    Article  CAS  Google Scholar 

  8. Spital A (1995) Mandated choice. A plan to increase public commitment to organ donation. JAMA 273: 504–506

    Article  CAS  Google Scholar 

  9. Rose EA et al. (2001) Randomized evaluation of mechanical assistance for the treatment of congestive heart failure (REMATCH) Study group: long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med 345: 1435–1443

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. JM Chen is an Assistant Professor of Surgery, Department of Surgery at Columbia University College of Physicians and Surgeons,

    Jonathan M Chen

  2. Y Naka is a Herbert Irving Assistant Professor of Surgery, Department of Surgery at Columbia University College of Physicians and Surgeons,

    Yoshifumi Naka

  3. the Morris and Rose Milstein, Johnson & Johnson Professor of Surgery and the Chairman of the Department of Surgery at Columbia University College of Physicians and Surgeons,

    Eric A Rose

Authors
  1. Jonathan M Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshifumi Naka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric A Rose
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan M Chen.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Related links

Related links

Web links

United Network for Organ Sharing

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chen, J., Naka, Y. & Rose, E. New strategies to expand the donor pool: are they misguided?. Nat Rev Cardiol 1, 2–3 (2004). https://doi.org/10.1038/ncpcardio0011

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpcardio0011

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing