Donor Organ Utilisation Efficiency in LVAD Bridge-to-Transplant Versus Direct Heart Transplant

Author(s): Aisha Alyassi, Dina Mistarihi, Fatma Almadani, Lulwa Mohamed Ahmed Abdalla, Roudha Almuqahwi, Gana Ali Ahmad Tahmaz, Shahd Imad Eldin Ahmed Hamad, Arij Alasfour, Fatima Hadif Rashid Abdalla Alowais, Jawahir Ali Hamad Al Sulaimani

Heart transplantation is a significant surgical intervention with a scarcity of donated organs constituting one of the biggest challenges registering high risk that informed the need to develop means of increasing utilisation of the available organs while fostering patients' positive outcomes. As a bridge-to-transplant, LVADs are commonly used. Restoring Direct heart transplantation is the other option where suitable organs are available immediately. The setting, comparative efficiency and outcomes of such strategies thus warrant further study to inform clinical practice and policies. In turn, this meta-analysis sought to assess the donor organ utilisation efficiency, post-LVAD BTT, direct HT recipient survivability, and medical complication profiles. The goal was to recognise each patient's strengths and flaws to enhance their use in clinical activities and resource management. The databases PubMed, Embase and Cochrane Library were searched to screen the literature systematically regarding the comparison of the two strategies. Data extraction focused on key outcomes: institutional donor organ acceptance rates, posttransplantation survival rates, time to transplantation, and perioperative complication. Post hoc comparisons were carried out to examine the heterogeneity and conclusiveness of the resulting data. The review concluded decreased late survival for each plan while the ten-year survival analysis was equal. Patients getting an LVAD had relatively better preoperative profiles but higher pre-transplant morbidity of infection and LVAD-related complications, as well as longer waiting times. Living donor recipients experienced fewer complications before transplantation surgery, but newer issues included ischemic injury and complexity in the allocation of grafts. We found that there was higher donor organ wastage in the LVAD group because of the long waiting period and the complications that come with it. The present metaanalysis compares both strategies' effectiveness while shedding light on their challenges. Better allocation of the organ, better management of the LVAD, and targeted treatment trajectories are needed to show beneficial results. These conclusions require interprofessional interaction between clinicians, policymakers, and researchers to improve transplantation processes and respond to organ deficiencies.