Extended Criteria Donor Use in Heart Transplantation: A Promising Strategy to Expand the Donor Pool

Background: To address organ shortage and reduce waitlist mortality, the use of extended criteria donors (ECDs) in heart transplantation is increasing. Methods: We retrospectively analysed outcomes in 236 heart transplant recipients: 140 received standard donor (SD) hearts and 96 received ECD hearts. Results: No significant differences were found in early or mid-term survival between the SD and ECD groups with a 30-day mortality rates of 13% vs. 10% (p = 0.662) and estimated 1-year survival of 75% (95% CI: 62.3–78.3%) and 71% (95% CI: 55.3–76.2%) (p = 0.556), respectively. Mechanical ventilation prior to transplant (p < 0.001), ischemic time (p = 0.022), peripheral vascular disease (p = 0.011), and chronic obstructive pulmonary disease (p = 0.022) were the only independent predictors of mortality. Conclusions: In our cohort, heart transplantation using ECD was not associated with increased early or mid-term adverse events. This approach may help expand the donor pool without compromising post-transplant outcomes.