Evolving Characteristics of Heart Transplantation Donors and Recipients

Although the burden of end-stage heart failure continues to increase, the number of available organs for heart transplantation (HT) remains inadequate. The HT community has been challenged to find ways to expand the number of donor hearts available. Recent advances include use of hearts from donors infected with hepatitis C virus as well as other previously underutilized donors, including those with left ventricular dysfunction, of older age, and with a history of cocaine use. Concurrently, emerging trends in HT surgery include donation after circulatory death, ex vivo normothermic heart perfusion, and controlled hypothermic preservation, which may enable procurement of organs from farther distances and prevent early allograft dysfunction. Contemporary HT recipients have also evolved in light of the 2018 revision to the U.S. heart allocation policy. This focus seminar discusses recent trends in donor and recipient phenotypes and management strategies for successful HT, as well as evolving areas and future directions. • Hearts from previously underutilized donors have increased the number of available organs as advances in surgical techniques have enabled procurement of organs from farther distances. • Contemporary heart transplant recipients have more comorbidities and are less often on durable mechanical support than in the past. • Future studies should address noninvasive methods of rejection surveillance, primary graft dysfunction, and xenotransplantation.