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Before Transplantation | Heart

HEART TRANSPLANTATION

Remarkable progress has been made with respect to heart transplantation over the past 3 decades. Heart transplant is now an option for treatment for end-stage heart failure.

MATCHING HEART FROM A DECEASED DONOR

To match organs between deceased donors and potential recipients there is a centralized computer network — called UNetSM — available 24 hours a day, seven days a week. The network – run by the United Network for Organ Sharing (UNOS) — links all transplant hospitals and organ procurement organizations using a secure passwords.

Medical information about the deceased donor is matched against transplant candidates. In general, this "match run" automatically creates a ranked list of suitable candidates for each organ based on several factors including:

• Blood type
• Geographic factors (distance between the potential recipient and the donor)
• Degree of medical urgency

Heart Allocation

Patients on a waiting list for a heart transplant are assigned a status code indicating their degree of medical urgency. In addition, the system allocates hearts locally first, and then in a specific sequence by zone.

Expanding the Pool of Donated Livers

There several ways to increase the pool of hearts from deceased donors including accepting organs from "extended criteria donors" (ECD). Although there is no universally accepted definition of ECD, some of the criteria are advanced donor age; longer time that the donated liver is without blood supply; need for medications to increase blood pressure in the donor; and donation after the donor’s heart stops beating.

Transplant doctors continue to evaluate the risks to the recipient associated with ECD organ transplantation.

VENTRICULAR ASSIST DEVICES (LVADS)

The difference in number between potential heart transplant recipients and available donors has created a need for circulatory assist devices to support the recipient’s heart. Ventricular Assist Devices (LVADs) are sometimes used as a "bridge-to-transplant." These mechanical devices are surgically implanted to help a diseased heart pump more effectively. LVADs significantly improve can patient’s health and survival rate.

Destination therapy (DT) refers to the use of some of these pumps to permanently support the heart in patients who are not transplant candidates.

References
Childress. Organ Donation: Opportunities for Action. National Academies Press: Washington, DC; Report of the Institute of Medicine Committee on Increasing Rates of Organ Donation
Guiding principles on human organ transplantation. World Health Organization. Lancet 1991;337:1470–1471
OPTN: Organ Distribution. Allocation of Thoracic Organs. Policy 3.7
Ramakrishna. Ann Card Anaesth. 2009:155-65