option for severe CONGENITAL HEART DISEASEsuch as
hypoplastic left heart syndrome (HLHS) as well as
hypertrophic CARDIOMYOPATHYand end-stage HEART
FAILURE. South African heart surgeon Christiaan
Barnard (1922—2001) performed the first human
heart transplantation in 1967, when he replaced
the badly diseased heart of 53-year-old Louis
Washkansky with the healthy heart of 25-year-old
Denise Darvall who died in an accident. Though
Washkansky lived only 18 days with the new
heart, the OPERATION catapulted cardiovascular
medicine into a new era. Today cardiovascular
surgeons perform about 2,200 heart transplant
operations a year in the United States. More than
70 percent of donor heart recipients live at least 5
years; the longest survival is 24 years.
DONOR HEART SHORTAGE
More than 4,000 people wait on the donor HEART
list, yet donor hearts will be available for little
over half of them. Many people who could be
heart donors are not. Surgeons must place the
donor heart in the recipient within four hours of
the donor’s death. Because many people have
not made decisions in advance about organ
donation, the time it takes to obtain the family’s
permission may make it too late to use the heart.
There is no cost to the donor’s family for removal
of donated organs.Heart transplant recipient criteria Though
many people may become critically ill with CAR-
DIOVASCULAR DISEASE(CVD), heart transplantation is
a viable option primarily for end-stage heart fail-
ure. Health experts estimate that heart transplants
could save the lives of 25,000 or more people each
year who currently die as a result of heart failure,
though the severe shortage of donor hearts
restricts heart transplantation to people who are
dying from heart failure yet are otherwise
healthy—people who have both great need and
great potential for survival. Conditions that may
result in heart transplantation include
- end-stage heart failure for which medical ther-
apies are ineffective, typically resulting from
inoperable CORONARY ARTERY DISEASE(CAD), inop-
erable VALVULAR HEART DISEASE, and cardiomy-
opathy- life-threatening ARRHYTHMIA that does not
respond to other treatment
- life-threatening ARRHYTHMIA that does not
- inoperable congenital malformations of the
heart, such as HLHS and tetralogy of Fallot,
when surgical reconstruction of the heart either
fails or is not likely to be successful
Though numerous clinical criteria establish the
severity of cardiovascular status, typically LEFT VEN-
TRICULAR EJECTION FRACTION(LVEF) that falls below
25 percent is the decisive factor. LVEF represents
the percent of blood in a full left ventricle that the
heart pumps into the body with each contraction
of the left ventricle. The amount of blood that
enters the body is the stroke volume. A normal
LVEF is 55 percent or higher; an LVEF of 40 per-
cent is moderately debilitating. At 25 percent,
there are symptoms of cardiovascular distress
(such as shortness of breath and ANGINA PECTORIS)
even at rest and the person is unable to perform
most physical activities.
As well, there are general eligibility criteria to
ensure optimal chance for survival after transplan-
tation. These general criteria for heart transplanta-
tion include- expectation of one year or less survival
- age 65 or younger (though an older person
who meets all other criteria may be accepted as
a recipient) - otherwise good health
- capable of and willing to comply with lifelong
medical care
Various health circumstances tend to preclude
consideration for heart transplantation, though
they are not absolute. Called comorbid conditions,
these include- INSULIN-dependent DIABETES with NEPHROPATHY,
NEUROPATHY, orRETINOPATHY(damage to KIDNEYS,
nerves, or eyes) - primary irreversible kidney disease (not related
to cardiovascular disease) - primary irreversible LIVERdisease such as CIR-
RHOSIS(not related to cardiovascular disease) - cancer within the previous five years (except
SKIN)
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