Donor management and selection for heart transplantation

The success of cardiac transplantation has led to its widespread application for all etiologies of end-stage heart disease. As a result, this has resulted in a severe shortage of available donor organs. In light of an increasing organ demand with a stable supply, efficacious donor management and meticulous selection is crucial in maintaining excellent outcomes with cardiac transplantation. It is now increasingly common to push the envelope by expanding criteria for donor selection. This has translated into harvesting of older donor hearts, from more unstable donors as well as from more distant locations. Of utmost importance is that when the decision is made to proceed with cardiac transplantation, the risk/benefit ratio associated with cardiac transplantation in that particular patient must be weighed against the mortality and morbidity risk while remaining on the heart transplant waiting list.