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Predicted Heart Mass for Donor Organ Allocation: Getting Closer to the Target.

Donor-recipient size matching is an essential part of the organ allocation process that leads to successful heart transplantation. Although undersized grafts have the ability to remodel, with evidence of increased left ventricular diameter and wall thickness as early as 5 weeks post-transplant,1 these morphological adaptations may not suffice to maintain normal cardiac output in the recipient. Graft failure, which can involve one or both ventricles, portends high subsequent mortality, and can also result in chronic morbidity, including end stage renal disease.2 Given the negative consequences of heart undersizing, donor-recipient size mismatch continues to be among the top reasons for donor heart nonacceptance, and many of these precious organs are ultimately discarded.3 With a finite number of available organs, there is general agreement that accurate indicators of heart size are needed to maximize organ utilization and prolong post-transplant survival. As such, the reliability of surrogate measures to estimate left ventricular mass merits close consideration.