Cardiac Donor Evaluation
Heart transplantation remains the most effective treatment for end-stage heart failure. Every transplant center has the prerogative to formulate its own organ acceptance criteria. This chapter focuses on the evaluation of the cardiac donor. It describes the epidemiology of cardiac donors and provides a brief summary of the US heart allocation system. The chapter reviews the physiologic changes that occur following brain death. It then discusses the use of ex-vivo perfusion storage technology as a means for assessing organ viability and as a tool enabling donation after circulatory death. Organ allocation in the USA is facilitated by United Network of Organ Sharing, which divides the country geographically into 58 donor service areas, each administered by an organ procurement organization. Following brain death, dysregulation of the autonomic and endocrine systems creates a variety of physiological derangements that put significant stress on the heart.
