Abstract:

Objective Brain-dead donors serve as the primary source of hearts for transplantation globally.They are prone to severe hemodynamic instability and internal homeostatic disturbances. Inadequate management can exacerbate myocardial injury，leading to cardiac dysfunction and subsequent discard of the donor heart. Therefore，establishing a systematic and scientific framework for donor heart assessment and donor management is crucial for improving graft quality and utilization rates. Methods A retrospective analysis was conducted on the characteristics of brain-dead donors whose hearts（for clinical transplantation）were maintained and procured in the donor care unit（DCU）of the organ procurement organization（OPO）department at Zhongnan Hospital of Wuhan University between January 2021 and December 2025. Combined with a review of the literature，the experiencein managing and maintaining brain-dead donors for heart donation was summarized. Results During the study period，a total of 407 cases of donation after citizen’s death were maintained，a total of 95 hearts were procured for transplantation，yielding a utilization rate of 23.34%. The donor cohort comprised 82 males and 13 females，with a mean age of（44±10）years and body mass index（BMI）（23.71±3.35）kg/m2 . Comorbidities included a history of hepatitis B（n ＝ 5），hypertension（n ＝ 44），and diabetes（n ＝ 8）. Prior to procurement，none of the donors had active bloodstream infections. All donors were in sinus rhythm，with an average heart rate was（90.93±9.84）beats/min and mean arterial pressure of（78.47±16.69）mmHg（1 mmHg ＝ 0.133 kPa）. Key biochemical markers included high-sensitivity troponin Ⅰ 1.15×10-5 mg/L（2.70×10-5 mg/L）and N-terminal pro-brainnatriuretic peptide 2.63×10-4 mg/L（4.72×10-4 mg/L），data were expressed as median（interquartile range）. Hemodynamic support with low-to-moderate dose norepinephrine was required in 13 donors. The mean left ventricular ejection fraction of the procured hearts was（61.58±3.21）%. Left ventricular or septal wall thickening was observedin a few donors，with no wall thickness exceeding 14 mm. Conclusion Our data indicate that a systematic and scientific protocol for brain-dead donor heart assessment and management can maintain a relatively high utilization rate while ensuring graft quality. Rigorous monitoring of physiological parameters，proactive circulatory support，and judicious pharmacologic intervention are pivotal for preserving donor heart function. 

Key words:

Brain death donor, Donor heart assessment, Donor management

摘要：

目的 脑死亡供者是全球临床供心的主要来源，由于供者脑死亡后极易出现严重的血流动力学紊乱和内环境失调，若管理维护不当，可能加重心肌损伤，导致心脏功能下降，造成供心废弃。系统、科学的供心评估体系与供者管理方案，对改善供心功能、提升供心利用率意义重大。 方法 回顾性分析2021 年 1 月至 2025 年 12 月武汉大学中南医院人体器官获取组织（organ procurement organization，OPO）科管理，并在供者维护单元（donor care unit，DCU）内接受供者维护，最终完成捐献心脏（用于临床移植）的脑死亡供者病例特点，结合文献资料，总结捐献心脏的脑死亡供者管理及维护经验。 结果 共获取公民逝世后器官捐献案例 407 例，用于临床移植的心脏 95 例，供心临床利用率为 23.34%。其中，男性 82 例，女性 13 例，年龄为（44±10）岁，体质指数（body mass index，BMI）为（23.71±3.35）kg/m2 ，既往合并乙肝病史者 5 例、高血压 44 例、糖尿病 8 例。所有供者在获取前均无活动性血流感染，心电图提示为窦性心律，平均心率为（90.93±9.84）次 /min，平均动脉压为（78.47±16.69）mmHg（1 mmHg ＝ 0.133 kPa），获取前高敏肌钙蛋白Ⅰ及脑钠肽前体水平分别为 1.15×10-5 mg/L（2.70×10-5 mg/L）和 2.63×10-4 mg/L（4.72×10-4 mg/L），13 例供者使用小至中等剂量去甲肾上腺素等药物维持血压，供心平均射血分数为（61.58±3.21）%，少数供者存在左室壁及室间隔增厚的情况，但室壁厚度均未超过 14 mm。 结论 通过系统、科学的脑死亡供心评估及供者管理，可在保障供心质量的同时，将供心利用率维持在较高水平。严格的生理指标监测、积极的循环支持及谨慎的药物使用是维护供心功能的关键措施。

关键词:  , 脑死亡供者 , 供心评估 , 供者维护