A Stroke in the Donor That Strikes the Recipient Revisiting Hearts From Young Donors

Heart transplantation (HT) in the United States is most commonly performed as a donation after brain death. In the United States, brain death accounts for 2% of adult inhospital deaths and has been defined by the Uniform Determination of Death Act as an "irreversible cessation of all functions of the entire brain, including the brainstem." This determination is typically made clinically.1 Brain death in an organ donor is associated with a cascade of physiologic and hemodynamic changes that may adversely affect a donor heart. Initially, an increase in intracranial pressure leads to bradycardia with a compensatory increase in cat echolamine release. This release results in tachycardia, hypertension, peripheral vasoconstriction, end-organ hypoperfusion, as well as myocardial damage.2, 3 Early studies have reported that the use of donors who experienced brain death due to stroke was associated with a higher mortality and a higher rate of primary graft dysfunction, although more contemporary studies did not corroborate these observations.4-8 These discrepant findings have been attributed to