Marginal donor grafts in heart transplantation: lessons learned from 25 years of experience

Heart transplantation represents an established procedure in end-stage heart failure patients and results in satisfying long-term results. However, this surgical therapy is continuously limited by severe and progredient donor organ shortage in the last years. Therefore, adequate and optimal utilization of all suitable donor organs is mandatory to increase graft availability. Evidence exists that certain 'standard' donor criteria can be significantly liberalized to increase the available donor pool by accepting 'Marginal Donors' who would, under conventional transplant guidelines, be declined as potential organ donors. The aim of this study was to review the available literature with regard to definitions and experiences with 'marginal' donor hearts and to discuss critically the controversies of numerous entities of donor criteria, which might be successfully liberalized. This review is thought to give an up-to-date overview of a modern concept of cardiac allograft acceptance based on a 25-year experience with heart transplantation.