Innovative strategies to increase cardiac donor availability

Abstract

Heart transplantation is a life-saving procedure for many people throughout the world. Data shows that in 2024, there was an increase in the volume of adult heart transplantation in the United States even as there was a decrease in the volume of pediatric heart transplantation to the lowest volume in a decade. Organ availability remains a major limiting factor affecting transplant volume. This mandates that innovation must take place to increase the supply of donor organs. While some strategies such as donation after cardiac death, hepatitis C virus + transplantation, and ABO-incompatible transplantation have increased the pool for donation, it still falls short of meeting the demand. Other proposed strategies include splitting the donor heart to provide multiple partial heart transplants, domino partial heart transplantation, changes in legislation including opt-out legislation, and xenotransplantation. Further evolution and refinement of these strategies will make a meaningful impact on patients awaiting life-saving heart transplants.

Keywords: Heart transplantation; Partial heart translation; Domino transplantation; Organ availability; Valvular transplantation

Core Tip: Heart transplantation is a procedure for extending the life of patients subject to heart failure but is limited in capacity by the availability of organ donations. Here we present a review on surgical, medical and policy innovations that can be used to increase the availability of donor organs for the general public.