ReviewThe echocardiographic risk assessment of donor hearts for consideration of transplantation

Pediatric patients waiting for heart transplantation experience the highest waiting list mortality compared to all other age groups and across all solid organ waiting lists. A significant number of potential donor hearts go unutilized every year due to “marginal” quality. Echocardiography is one of the single most important tools for the examination of donor heart function. Echocardiography can identify donor hearts that can be used successfully in transplantation despite the presence of clinical factors that could lead to exclusion. The echocardiographic risk assessment of donor hearts for consideration of transplantation involves an understanding of the donor's clinical status and mechanism of brain death, the role of serial echocardiogram, and the recognition of the limitations of echocardiography. This review looks at donor cardiac function and the echocardiographic assessment in general, discusses the growing role for serial echocardiography, and examines the correlation between echocardiographic findings and patient outcomes. The limitations of donor echocardiography are also discussed as well strategies to improve the quality of donor echocardiograms.