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J Thorac Cardiovasc Surg 1994;108:1151
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Donor-recipient size match in heart transplantation

Gulshan K. Sethi, MD, Jack G. Copeland, MD

Department of Surgery
Section of Cardiovascular and Thoracic Surgery
The University of Arizona Health Sciences Center
Tucson, AZ 85724

Reply to the Editor:

We are delighted to read the positive and complimentary response of Drs. Parry and Large to the message which we attempted to convey in our paper, "Clinical Significance of Weight Difference Between Donor and Recipient in Heart Transplantation." In matching the donor heart with the recipient, we pay attention not only to the weight criteria, but also to other factors, such as general body habitus, height, activity level of the donor before brain death, inotropic support, central venous pressure, presence or absence of infection, and electrocardiographic and echocardiographic findings. For example, we believe that a normal heart from a marathon runner, who is receiving minimal inotropic support, will probably function well in any recipient, regardless of weight and height difference between the donor and the recipient.

Drs. Parry and Large's suggestion to match the donor heart according to height and not according to weight is intriguing. However, they do not provide us with precise guidelines for acceptance and rejection of the donor heart on the basis of height criteria. Inasmuch as we have not performed the data analysis considering height as an independent risk factor, we are not in a position to support or refute their recommendation.

We agree with Drs. Parry and Large that among adults there is more variation in weight than in height, and in some patients, because of congestive heart failure, the apparent weight may not be indicative of true body mass. They make a strong argument that matching the donor with recipient according to height is superior to the weight criterion, but they fail to provide data to support their hypothesis.

We look forward to hearing from them about their experience and the specific guidelines for acceptance and rejection of the donor heart on the basis of the height criterion.





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