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Singh et al. Vessel Plus 2018;2:33 I http://dx.doi.org/10.20517/2574-1209.2018.28 Page 11 of 17

Figure 1. Deceased donor heart programme in the UK, 1 April 2007 - 31 March 2017, number of donors, transplants and patients on the
active transplant list at 31 March

Forays into xenotransplantation as a potential pool of organs to solve the problem of donor-organ supply
[106]
were also touted but to date, these remain in the experimental phase .

The decision to accept a marginal donor organ is made on a recipient focused individualized basis rather
than specific values, parameters or conditions [Figure 2].

The number of “standard donors” for kidney transplants were first notably reduced after the implementa-
tion of the compulsory wearing of seat belts in the United Kingdom which was approved by parliament
[107]
in 1982 and became law on 1 February 1983 . Other legislations include zero-tolerance drinking-and-
driving law resulting in fewer traffic accidents with fatal victims [108] . During this time period the United
Kingdom Transplant Support Service Authority demonstrated a 12% increase in the number of cardiac do-
[109]
nors aged greater than 41 years between 1988 and 1995 . The initial reluctance to use organs from older
donors especially the heart was due to longstanding dogma that older hearts were thought to more suscep-
[110]
tible to the catecholamine flood that accompanies brain death . Internationally, gun crime has also been
closely associated with donor organ availability. Studies in Brazil have shown a direct correlation between
urban violence and gun crime to organ donors [111,112] .

Initial studies exploring the extended age criteria showed no significant difference in terms of left ventricu-
lar function and the incidence of infection and rejection [109,113] . The risk of dying on the waiting list out-
[114]
weighed that of receiving an organ from an older donor .