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The Paradoxical Relationship Between Donor Distance and Survival After Heart Transplantation

Wednesday, May 17, 2017

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Source Name: Annals of Thoracic Surgery


Todd C. Crawford, J. Trent Magruder, Joshua C. Grimm, Clinton D. Kemp, Alejandro Suarez-Pierre, Kenton J. Zehr, Kaushik Mandal, Glenn J. Whitman, John V. Conte, Robert S. Higgins, Duke E. Cameron, Christopher M. Sciortino

UNOS data for over 14,500 isolated heart transplant patients were analyzed to assess the relationship between donor distance from the transplantation center and recipient mortality at 30 days and 1 year.   Ischemic time correlated with donor distance.  Mortality was reduced for donor distances over 25 miles, and the reduction was highest for distances greater than 500 miles.  


Some thoughts for further discussion on this most important topic: Table 1 presents relatively uniform average cold ischaemic times across the 11 UNOS regions ( average 3 hours 18 minutes by my counting) in spite of average distances between 135 ( region 1) and 308 ( region 6) miles. We do not know how far the recipients had to travel, an important consideration for the British system as it affects the cross clamp time. I vividly remember a recent procurement of a heart for the same centre, eighty miles from my base * that left me with the impression that proximity of donor and recipient OR’s does not necessarily contribute to performance. The physiologic dynamics of the cerebroplegic heart of a DBD and the variation in resources in the procurement site may account for uncontrolled confounding that may explain the paradox. Similarly, human factors may affect the performance, in the same manner that affect defence or sports. * in Britain, organ procurement and implantation have been uncoupled since 2010, and direct communication between surgeons is now discouraged in favour of two intermediaries : donation and recipient coordinators of variable background, experience and skill mix.

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