Our Summary

This research paper examines the impact of donor sequence numbers (DSN) on heart transplants. DSNs are essentially a ranking system for organ donors, and a higher DSN might be viewed as indicating a poor-quality donor. The study looked at adult heart transplants performed between 2015 and 2022 and divided them into two categories: high-DSN (42 or above) and low-DSN (below 42).

The researchers found that donors with a high-DSN tended to be older, had higher creatinine levels (a waste product in the blood that can indicate kidney disease), had diabetes, hypertension, and a lower left ventricular ejection fraction (a measure of heart function). The recipients of high-DSN heart transplants were also often older, more likely to be female, had blood type O, and were of lower status at the time of the transplant.

However, when they compared the outcomes of the high-DSN and low-DSN transplants, the researchers found no significant difference in complications after the surgery, length of hospital stay, or survival rates after one and three years.

The conclusion is that a high-DSN should not be viewed as a risk factor for poor outcomes after a heart transplant. In fact, accepting organs with a high-DSN could potentially increase access to heart transplants for patients who are currently considered lower priority.

FAQs

  1. What is a donor sequence number (DSN) and how does it affect heart transplants?
  2. What were the findings of the study about the impact of high-DSN and low-DSN on heart transplant outcomes?
  3. Can a high-DSN be considered a risk factor for poor outcomes after a heart transplant?

Doctor’s Tip

A helpful tip a doctor might tell a patient about heart transplant is to trust the transplant team’s expertise in selecting the best donor organ for them, regardless of the donor sequence number. It’s important to focus on post-transplant care and follow all recommendations to ensure a successful recovery.

Suitable For

Patients who are typically recommended for heart transplants are those with end-stage heart failure that is not responsive to other treatments such as medications, lifestyle changes, or heart devices. These patients often experience symptoms such as severe shortness of breath, fatigue, chest pain, and fluid retention. They may also have a poor quality of life and a decreased life expectancy without a transplant.

In addition, patients who may be considered for a heart transplant are those who have a high risk of sudden cardiac death or complications from their heart condition. These patients may have a history of heart attacks, heart valve disease, congenital heart defects, or cardiomyopathy.

It is important to note that not all patients with end-stage heart failure are eligible for a heart transplant. Factors such as age, overall health, presence of other medical conditions, and ability to adhere to post-transplant care guidelines are also taken into consideration when determining a patient’s candidacy for a heart transplant.

Timeline

Before a heart transplant:

  • Patient is diagnosed with end-stage heart failure and has exhausted all other treatment options
  • Patient is evaluated by a transplant team to determine if they are a suitable candidate for a heart transplant
  • Patient is placed on the transplant waiting list and waits for a suitable donor heart to become available
  • Patient undergoes extensive testing and preparation for the surgery
  • Patient may experience worsening symptoms of heart failure and decreased quality of life

After a heart transplant:

  • Patient undergoes the heart transplant surgery, which typically lasts several hours
  • Patient is closely monitored in the intensive care unit (ICU) immediately after the surgery
  • Patient starts a regimen of immunosuppressant medications to prevent rejection of the donor heart
  • Patient undergoes regular follow-up appointments and testing to monitor the function of the new heart
  • Patient undergoes cardiac rehabilitation to help regain strength and endurance
  • Patient may experience complications such as infection, rejection, or side effects from medication
  • Patient gradually resumes normal activities and experiences improved quality of life, with the potential for increased longevity.

What to Ask Your Doctor

  • What is my current position on the heart transplant waiting list and how does the donor sequence number (DSN) factor into my potential match?
  • Can you explain the potential risks and benefits of receiving a heart transplant from a donor with a high DSN?
  • How do you determine the quality of a donor heart and what factors do you consider when evaluating a potential match for me?
  • Are there any specific precautions or monitoring that will be necessary if I receive a heart transplant from a donor with a high DSN?
  • How will the DSN of the donor impact my recovery process and long-term outcomes following the heart transplant?
  • Are there any additional tests or evaluations that should be done to assess the compatibility and suitability of a potential donor heart with a high DSN for me?
  • Can you provide information on the success rates and survival rates associated with heart transplants from donors with high DSNs compared to those with low DSNs?
  • How will the DSN of the donor impact the likelihood of rejection or complications following the heart transplant procedure?
  • Are there any alternative treatment options or considerations that I should be aware of if a heart transplant with a high DSN is recommended for me?

Reference

Authors: Zhou AL, Daskam ML, Ruck JM, Akbar AF, Larson EL, Casillan AJ, Kilic A. Journal: J Surg Res. 2024 Aug;300:325-335. doi: 10.1016/j.jss.2024.05.008. Epub 2024 Jun 4. PMID: 38838430