Heart Transplant Update

It had all the makings of a science fiction story when, nearly half a century ago, surgeons implanted a chimpanzee heart into a human. That heart kept the patient alive for only an hour and a half, but the groundbreaking procedure brought us one step closer to today and a world where approximately 2,000 patients in the United States will receive new human hearts this year, and where the majority of those recipients can expect to live at least another 10 years.

What's truly remarkable, though, is that a successful heart transplant is no longer about just enabling a patient to survive for a year or a decade. The focus is on helping patients achieve a better quality of life. "It's about the 65-year-old who couldn't take two steps now being able to lift her grandchild and live a full life," explains Warren Rosenblum, M.D., Assistant Clinical Professor of Medicine at Columbia University Medical Center Division of Cardiology.

According to Dr. Rosenblum, the "modern age of heart transplants" began in the 1980s with the advent of powerful immunosuppressant drugs. These drugs, which help prevent a recipient's body from rejecting the foreign heart, are now so effective that organ rejection is fairly uncommon. The downside is that in some cases these medications (which you need to take for the rest of your life if you receive a donor organ) can cause complications such as infection, diabetes, kidney disease, and cancer. However, Dr. Rosenblum stresses that these cases are an exception, not the rule.

Of course, the risk of complications is often worth it to the 3,000 or so people in the nation with end stage heart failure who, at any given moment, are waiting for a heart. The number of people who are candidates for heart transplants has fluctuated in the past decade due to other changes in cardiovascular medicine. Specifically, there have been advances in the use of a ventricular assist device (VAD), a mechanical pump that improves heart function and blood flow.  As VADs have gotten smaller and more reliable, they're now able to be used as a bridge to transplant or a bridge to recovery, according to Dr. Rosenblum. That means that with this device, a patient who may have been a candidate for a transplant may no longer need the surgery because the VAD is so effective. Other patients who in the past may not have been able to survive the long wait for a donor heart are now able to do so with a VAD.

As VADs become more sophisticated, they are increasingly being considered as "destination therapy," which means they are used as a permanent form of treatment and replace the need for a heart transplant. "That's the Holy Grail," says Dr. Rosenblum, "that [with these devices] patients will be able to live longer and healthier lives."

Those for whom transplant surgery is still the best option must wait for a donor. First, you must be considered a good candidate. Every hospital has its own criteria, so, for instance, there is no universal cut-off for age. However, survival is less likely with advanced age. The greatest challenge for those seeking a new heart, however, is donor supply, according to Dr. Rosenblum.  Helping to increase donor awareness is something that anyone can do. The U.S. Department of Health and Human Services offer resources at organdonor.gov to help you spread the word and take part in activities to promote organ donor programs.



"Explore Heart Transplants." National Heart, Lung and Blood Institute. n.d. Web. April 13, 2012

Fitzpatrick, Laura. "A Brief History of Heart Transplants." TIME. November 16, 2009. Web. April 13, 2012

"Heart." The Organ Procurement and Transplantation Network (OPTN) and the US Scientific Registry of Transplant Recipients (SRTR) Annual Data Report 2010. n.d. April 15, 2012.