Determining Factors of Heart Quality and Donor Acceptance in Pediatric Heart Transplants; A Review of the Underlying Barriers to Organ Donation

Roberson, Wesley, School of Engineering and Applied Science, University of Virginia
Porter, Michael, EN-Eng Sys and Environment, University of Virginia
Baritaud, Catherine, EN-Engineering and Society, University of Virginia

There are many people in need of new hearts for a variety of medical reasons, far more people than available hearts. The technical project aims to use data analysis to help doctors understand which available heart donations are good to use. Physicians receive overwhelming amounts of data when deciding whether to accept an available donor heart for their patient, and there is a need to determine what data is important and how to decide whether a heart is good in the heart acceptance process. The science, technology, and society (STS) topic reviews ethical questions and other barriers associated with choosing to donate organs. The two projects are very tightly coupled; the technical project deals with using available hearts better, and the STS research deals with getting more hearts and other organs. Both projects have the ultimate goal of providing hearts and organs to more people in need, to save more lives.
Analyzing the organ measurements, echocardiogram measurements, and identifying characteristics of the donor, specifically through graphing each variable over time and whether a value is normal, or “in range”, revealed the normal medical patterns in the donor hearts. Understanding what the measurements often look like in the process will help physicians understand any misconceptions they might have or strengthen any assumptions they operate under when deciding whether to accept the donor heart. The statistical analysis and logistic regression helped to isolate the important factors for physicians to consider amid the enormous volume of data.
A dashboard displaying trends for each variable was created, with boxplots of measurements over time, bar graphs of percentage of in range measurements, tables of the same information, and boxplots of extreme measurements such as the final measured value. Chi-squared tests and logistic regression based on accepted versus rejected donor hearts were performed, which showed the predictors of ventricular valve disfunction, age, shortening fraction, and ejection fraction to be the only significant variables in predicting acceptance. These results confirmed the hypothesis that of the data physicians were using to make heart acceptance decisions, only echocardiogram data was important.
The technical project provided the original motivation behind researching the barriers to organ donation. Analyzing how to use the available hearts as efficiently as possible provoked wonder at why there were not more organs available and why more people did not donate when they died. These causes were sought out and collected. A variety of literature was reviewed to compile the reasons why people did not donate, and these reasons were categorized into different types. Pacey’s Triangle created a framework used to organize these types of barrier and explore the complicated relationships between them. The relationships that were identified were further analyzed to move toward a solution.
Through the organization of barriers to donation, it became apparent that the principal reasons people do not donate lie in the cultural division of Pacey’s Triangle. Further inspection revealed that apathy and indifference created or contributed to most of these cultural barriers. Misinformation and irrationality were also found to be secondary undergirding problems. Proposed solutions based on this conclusion included advertisements in departments of motorized vehicles, teaching pediatricians to bring up organ donation during routine checkups, and, perhaps most effectively, enlisting sports clubs to undertake donation awareness campaigns to their eager fanbases.
The research outlined here can help to ameliorate the lack of hearts, and more broadly, organs across the country and the world. The findings in the technical project help physicians use available hearts more efficiently in addition to deciding more easily whether each heart should be accepted. The conclusions in the sociotechnical research help change the cultural mindset regarding organ donation, thereby raising awareness and increasing donations.

BS (Bachelor of Science)
pediatric cardiology, heart transplantation, donor characteristics, organ donation, Pacey's Triangle

School of Engineering and Applied Science
Bachelor of Science in Systems Engineering
Technical Advisor: Michael D. Porter
STS Advisor: Catherine D. Baritaud
Technical Team Members: John Bullock, Megan Grieco, Ian Pedersen, Gracie Wright

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