Every donor heart must first be offered before it can be accepted.
It sounds obvious. Yet according to heart transplant surgeon Dr. Brian Lima, MBA, that’s exactly where too many potential donor hearts are falling out of the process.
“When we think about donor heart utilization, one important theme is that there are a number of donor hearts that never even make it to the assessment stage,” he explained during CompuMed’s recent webinar, Unlock More Donor Heart Opportunities.
According to Dr. Lima, one of the biggest barriers isn’t necessarily the condition of the heart itself.
“It’s the challenge of getting a full coronary anatomy workup,” he says.
As donation after circulatory death (DCD) heart transplantation continues to grow, this hurdle is becoming even more significant.
When the Bottleneck Happens Before the Offer
Current donor heart guidelines recommend coronary evaluation for higher-risk donors, typically using coronary angiography (heart catheterization).
The challenge is that heart caths aren’t always practical – or even possible – during donor evaluation.
“I have personally experienced evaluating a donor heart that met some of these higher-risk criteria and have been told, ‘We know you want a heart cath, but we can’t do it because this is a DCD donor,'” says Dr. Lima. “That means those hearts were never even evaluated for possible transplant.”
A recent study, based on SRTR data from 2023, illustrates the magnitude of this challenge. Among approximately 4,000 DCD donors younger than 55 years old, only about 15% ultimately became heart donors. Based on SRTR’s expected utilization model, Dr. Lima noted that 700 to 1,200 additional hearts may have been suitable for transplantation.
“It would be tremendously impactful if we could alleviate some of the hurdles to offering a DCD heart for transplant,” he says.
Reasons for DCD Cardiac Allograft Non-Use
The Information May Already Exist in CT Imaging
The encouraging part is that much of the information needed to decide whether a heart is suitable for transplant may already exist within CT imaging.
“It would be highly unusual, in my experience, to encounter a donor who hasn’t had a non-contrast chest CT,” says Dr. Lima. “That means the data is already there in a vast majority of cases.”
Those CT scans, often obtained as part of routine donor evaluation or for other clinical reasons, can provide valuable information about coronary artery calcification without requiring additional imaging.
For years, non-contrast CT has been used by medical professionals to calculate coronary artery calcium scores for patients at risk of heart disease. The same principle can help transplant teams better understand whether coronary artery disease is likely to be present in a donor heart.
“With that non-contrast chest CT, we can assign a score based on the number of white specs, or calcium, present,” says Dr. Lima. “The ability to quantify the amount of coronary artery calcium can provide plenty of information to determine whether that anatomy is suitable for a transplant.”
Rather than replacing every aspect of donor heart evaluation, calcium scoring provides another pathway – one that can help determine whether a heart should move forward for consideration or whether additional imaging is warranted.
What is an Agatston (Coronary Calcium) Score?
Coronary calcium scoring is a well-established method of estimating the likelihood of coronary artery disease using a routine non-contrast CT scan.
The scan measures calcified plaque within the coronary arteries and assigns an Agatston score. In general:
| Score | What it suggests |
| 0 | No detectable calcified plaque; very low likelihood of significant coronary artery disease |
| 1-99 | Mild calcification |
| 100-399 | Moderate calcification |
| 400+ | Extensive calcification and increased likelihood of significant coronary artery disease |
For donor heart evaluation, the score provides an objective screening tool that can help transplant teams determine when existing CT imaging may provide sufficient reassurance to offer or rule out a heart or when additional coronary evaluation is warranted.
Using Existing Imaging Instead of Starting Over
One of the greatest advantages is that this approach doesn’t require additional scans in many situations.
“A patient may have had a chest CT for a completely different reason days, weeks or even months earlier,” says Dr. Robert Falk, founder and chief medical officer of CompuMed’s longtime partner 3DR Labs. “That imaging may already contain the information you need. It simply hasn’t been analyzed from the perspective of donor heart evaluation.”
Coronary artery disease develops over time, making previously acquired imaging highly valuable.
“It does not need to be rescanned,” says Dr. Falk. “At the very start of the case, organ recovery teams can go back, analyze what’s already there and potentially avoid obtaining new imaging altogether.”
For cases that fall into a gray area, calcium scoring can also help determine whether more advanced imaging, such as coronary CT angiography (CCTA), should be the next step.
“We’re actually trying to make a complicated decision process simpler with smart, targeted use of existing imaging,” says Dr. Falk.
Making the Calcium Scoring Workflow Easy
CompuMed developed its coronary calcium scoring service with one goal in mind: eliminating barriers rather than creating new ones.
“We’re trying to provide answers sooner and increase trust in those answers,” says Lee Keddie, CEO of CompuMed. “A lot of that confidence comes from the imaging itself.”
The service is integrated directly into CompuMed’s existing workflow.
Organizations already uploading donor CT studies through CompuMed can simply request a coronary calcium score through the donor management portal as part of the evaluation process. If imaging remains at the donor hospital, a remote screen-sharing workflow is also available. When CT imaging cannot initially be obtained, CompuMed offers an additional rescue pathway to help organizations access the information they need.
The service is offered remotely and is available 24 hours a day, seven days a week.
Rethinking What’s Possible
Neither Dr. Lima nor CompuMed suggest that coronary calcium scoring replaces every heart cath. Instead, it offers another pathway for obtaining objective coronary information when traditional evaluation isn’t feasible – allowing more donor hearts to reach the transplant centers that ultimately decide whether they are a good fit for a patient.
As adoption grows, CompuMed is also helping connect transplant programs interested in a CT-first workflow with physicians and centers already using it, recognizing that collaboration will play an important role in expanding access to new approaches.
Ultimately, Dr. Lima believes the conversation extends far beyond coronary calcium scoring itself.
“It’s one of many examples where a routine standard diagnostic workup for a donor heart is kind of like, ‘Well, this is how we’ve been doing it for 20 years.’ But times have changed and technology has advanced. It begs the question: What is it that you actually want to know? And maybe we can leverage existing technology to get a more direct answer.”
As OPOs and transplant centers continue searching for ways to increase donor heart utilization, calcium scoring can help remove barriers so that more viable donor hearts have the opportunity to be evaluated – and hopefully, save lives.
Continue the conversation
Want to see how coronary calcium scoring could fit into your organization’s existing donor evaluation workflow?
Watch the full webinar, Unlock More Donor Heart Opportunities, to hear Dr. Brian Lima, Lee Keddie and Dr. Robert Falk discuss the workflow in greater detail.
You can also view Dr. Lima’s earlier webinar, “No Cath, No Problem,” which explores the research behind a CT-first approach for donor heart evaluation and its comparable transplant outcomes.
For additional questions or to take next steps, please contact CompuMed.
