How to Shorten the Wait for Heart Transplant
If you need a heart transplant, there are ways to shorten the wait.
Heart transplant is the best treatment for people with end-stage heart failure. Unfortunately, there aren’t enough donor hearts to go around. Many patients die waiting for one.
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But Cleveland Clinic heart transplant specialist Eileen Hsich, MD, has proposed a way to fix the problem. She recently published her recommendations in the medical journal Circulation: Heart Failure.
“There are three parts,” she says. “And we need to do them all at once to be successful.”
Dr. Hsich recommends:
Usually, ideal heart donors are younger than age 40 and don’t have any of the following:
“Today, we refuse two-thirds of organs because donors don’t meet ideal criteria,” says Dr. Hsich. “This isn’t always necessary.”
Instead of discarding these organs, Dr. Hsich suggests categorizing them as either:
Some high-risk or marginal hearts may be as good as “ideal” hearts for patients in need. Although the best option is to register more ideal donors, an alternative for immediate improvement in our system is to better use what we have, Dr. Hsich notes.
“The lifeboat will sink if it attempts to hold everyone,” says Dr. Hsich. “We need to set higher standards for getting on the transplant wait list.”
She knows it won’t be easy. But data can help. For example, stats show that people who have kidney disease or use tobacco don’t fare as well with a heart transplant. A ventricular assist device (VAD) could be just as helpful for these patients.
“More people should consider a VAD instead of seeking a heart transplant,” says Dr. Hsich.
Women and Hispanics are more likely to die on the wait list than men and whites. Same with patients in certain parts of the U.S.
The Organ Procurement and Transplantation Network has proposed changes to address these and other disparities. It recommends ways to give more transplants to people who need them most urgently.
Eventually we need to create an allocation score, like the one used for lung transplants, says Dr. Hsich. Doing this would be a huge task, however, given all the factors that determine a heart patient’s risk.
“There isn’t just one way to improve our heart transplant system,” says Dr. Hsich. “It will take a combination of increasing the donor pool, reducing the wait list and improving the allocation system.”