Background. Organ shortage has liberalised the acceptance criteria of grafts for heart transplantation, but which donor characteristics ultimately influence the decision to perform transplantation? For the first time this was evaluated using real-time donor data from the German organ procurement organization (DSO). Observed associations are discussed with regard to international recommendations and guidelines. Methods. 5291 German donors (2006–2010) were formally eligible for heart donation. In logistic regression models 160 donor parameters were evaluated to assess their influence on using grafts for transplantation (random split of cases: 2/3 study sample, 1/3 validation sample). Results. Successful procurement was determined by low donor age (OR 0.87 per year; 95% CI [0.85–0.89], ), large donor height (OR 1.04 per cm; 95% CI [1.02–1.06], ), exclusion of impaired left ventricular function or wall motion (OR 0.01; 95% CI [0.002–0.036], ), arrhythmia (OR 0.05; 95% CI [0.009–0.260], ), and of severe coronary artery disease (OR 0.003; 95% CI [<0.001–0.01], ). Donor characteristics differed between cases where the procedure was aborted without and with allocation initiated via Eurotransplant. 1. Introduction According to the International Society for Heart and Lung Transplantation (ISHLT), worldwide about 5000 heart transplants are carried out yearly [1]. In Germany in 2011, 366 heart transplantations were performed at 22 hospitals; however, 695 patients were placed on the waiting list in the same year [2]. Due to the existing organ shortage, the acceptance criteria for donor hearts have been increasingly liberalised. Numerous recommendations on the evaluation of potential donor hearts have been published [3–13]. But what about their implementation in daily work of transplantation coordinators? This study evaluates for the first time which factors ultimately influence the decision to use a graft for heart transplantation or not by using real-time data of donation procedures provided for allocation and decisions at recipient center level. The actual decision pathways in the donation process are discussed with reference to the published recommendations and guidelines. At different levels they are more or less triggered by the organ procurement organization (OPO) or recipient centers. Optimal evaluation of potential donor hearts is a cost-intensive purpose, including special cardiac diagnostic procedures like coronary angiography. Strategies to avoid a waste of resources have to be discussed in health policy. 2. Methods The national OPO, the German Foundation
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