Background. Procurement of hearts from cardiopulmonary arrest and resuscitated (CPR) donors for transplantation is suboptimal. We studied the influences of donor factors and regional wait times on CPR donor heart utilization. Methods. From UNOS database (1998 to 2012), we identified 44,744 heart donors, of which 4,964 (11%) received CPR. Based on procurement of heart for transplantation, CPR donors were divided into hearts procured (HP) and hearts not procured (HNP) groups. Logistic regression analysis was used to identify predictors of heart procurement. Results. Of the 4,964 CPR donors, 1,427 (28.8%) were in the HP group. Donor characteristics that favored heart procurement include younger age (25.5？±？15？yrs versus 39？±？18？yrs, ), male gender (34% versus 23%, ), shorter CPR duration (<15？min versus >30？min, ), and head trauma (60% versus 15%). Among the 11 UNOS regions, the highest procurement was in Region 1 (37%) and the lowest in Region 3 (24%). Regional transplant volumes and median waiting times did not influence heart procurement rates. Conclusions. Only 28.8% of CPR donor hearts were procured for transplantation. Factors favoring heart procurement include younger age, male gender, short CPR duration, and traumatic head injury. Heart procurement varied by region but not by transplant volumes or wait times. 1. Introduction For patients with advanced heart failure awaiting heart transplantation (HTx), donor heart supply remains a limiting factor in offering the ultimate treatment option. Efforts to optimize management of potential heart donors have led to increased utilization of donor hearts [1], yet this increase falls far short of the existing demands on organs for transplantation [2]. New avenues that would increase available donor hearts have been explored, including donation after cardiac death [3], ex vivo organ resuscitation [4], and, importantly, extended donor selection criteria [5]. Of these extended criteria, cardiopulmonary arrest and resuscitated (CPR) organ donors have significantly increased the potential organ donor pool. In the past decade alone, there has been a 90% increase in the number of organ donors who were successfully resuscitated after cardiopulmonary arrest [2] (Figure 1). We previously reported that the clinical outcomes of heart transplantation from CPR donors are similar to the outcomes from non-CPR donors [6]. This finding was also noted in other solid organ transplantation studies [7, 8]. Figure 1: CPR donor percentage of the total heart donors. Despite these encouraging reports, utilization of CPR donor hearts
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