There are far more patients waiting for hearts than there are donors. But help might be just a heartbeat away thanks to a new transplant program that provides patients with an alternative.
Three years ago, 78-year-old Fred Austin desperately needed a heart transplant and feared his age would be a problem.
“There’s only so many hearts," he says. "So they wanna’ be sure that the people that, uh, that get the hearts stay with them a while.”
To increase his odds, Fred signed up on both the regular transplant list and the new alternate heart transplant list.
He says, "I knew that if I was gonna’ get a heart, maybe that’s the only way I could get it.”
Alternate hearts are slightly damaged, come from older or diseased donors and are usually rejected for transplantation.
Dr. Hillel Laks says, "Unfortunately, there were also those patients who are desperately ill or dying and need a heart very urgently.”
Doctor Laks pioneered the first alternate heart program at UCLA.
He says, "For some of these patients, the alternative is a very high-risk assist device. And we believe that if you can get one of these hearts, that this is a better device than a mechanical device.”
He says patients on the alternate list get new hearts sooner.
"They wait about half the time of people on the regular list because across the country there are so many hearts like this that are not being used,” Dr. Laks says.
Fred received his new heart and is doing well. He’s grateful the alternate heart program gave him an option and he says, “it’s just another way to, to save your life, if, if that’s what it takes.”
Using imperfect or alternate hearts is not yet widely accepted and there are only a few hospitals in the country on board. Most are afraid to take the financial risk.
Fast Facts:
Approximately 5 million Americans have heart failure.
In 2003, heart failure contributed to 286,700 deaths in the U.S.
When heart failure becomes severe, a heart transplant may be necessary. Last year, 1,764 heart transplants were performed in the U.S.
There aren’t enough donor hearts to meet the needs of those on the transplant waiting list and some people die before a new heart becomes available.
Some hospitals are now using donor hearts that are still functioning, but for medical reasons would normally be rejected for donation.
Selective use of alternate hearts can be safe and successful and would increase the supply of donor organs by 25 to 30 percent.
Heart Failure
Heart failure occurs when the heart is unable to pump enough blood to meet the needs of the body. Patients may experience shortness of breath, fatigue, cough, inability to tolerate exercise and fluid retention.
As the condition progresses, the heart must work harder and harder to get enough blood to the body. The extra effort causes the heart muscle to enlarge, which further weakens the heart. Over time, the heart may eventually give out.
According to the American Heart Association, about 5 million Americans have heart failure. The condition can occur at any age, but is more common in older people. About 6.2 percent of men 65 to 74 and 4.1 percent of women have heart failure. In 2003, heart failure contributed to, or was an underlying factor, in 286,700 deaths.
One of the most common causes of heart failure is coronary artery disease (blockages in the heart’s arteries from a build-up of plaque). Heart failure may also be caused by high blood pressure, infection of the heart, heart valve disease, congenital heart disease or excessive use of alcohol or certain illicit drugs. Sometimes the cause of heart failure can’t be found.
Treating Heart Failure
Initially, doctors may try to treat heart failure with modification of diet and lifestyle, exercise and medication. Patients with coronary artery disease may benefit from bypass surgery or angioplasty. Defective heart valves can be replaced with prosthetic valves. Patients who have heart rhythm problems may benefit from a pacemaker or implantable defibrillator.
When standard medical treatments fail to provide relief, doctors may recommend a heart transplant. In this procedure, the patient’s diseased heart is removed and replaced with one from a deceased donor. Last year, 1,764 heart transplants were performed in the U.S. (UNOS data).
To get a new heart, doctors must first determine if the patient needs a transplant, could survive the surgery and is able to participate in follow-up care. Then the patient is placed on a waiting list for a heart matching the recipient’s blood type and body size.
Getting a new organ isn’t an easy process. Patients who are the sickest get first priority. And there aren’t enough donor organs to meet the needs of those needing a transplant. As of January 6, 2006, more than 3,000 people were on the transplant waiting list for a new heart. Median waiting times for a new heart for people 18 and older range from 107 days to 203 days. Some patients die before a donor heart becomes available.
Expanding the Donor Pool
Normally, doctors only use hearts from donors that meet very stringent criteria, because of the greater risk of complications and poor outcomes. However, the shortage of donor organs has some experts scrambling to find new ways to increase the donor pool. At UCLA doctors have developed an “alternate heart program” for transplant patients. Alternate hearts are those that are rejected for transplant, but may still have some use for patients. The alternate heart program may take organs from an expanded pool of donors, such as those with advanced age (over 55), having diabetes or history of hepatitis B or C, patients whose hearts had already stopped beating or children under 5.
Alternate hearts would not be given to recipients who are otherwise healthy and able to wait for a donor organ. But for those who don’t have time to wait for a suitable heart, or are too sick to otherwise be considered for transplant, an alternate heart may provide some hope.
UCLA Transplant Program Director, Hillel Laks, M.D., says alternate hearts are only used when patients have no other options. The important factor in choosing the option is to carefully balance the risk factors in the recipient and the donor. Patients must also be well informed of the risks. Research suggests selective use of alternate hearts can be safe and successful and would increase the supply of donor organs by 25 to 30 percent.
Web Resources
For information about heart failure or other heart diseases:
American Heart Association Web site.
For general information about heart transplants:
Transplant Living Web site.
United Network for Organ Sharing Web site.
U.S. Transplant Web site.
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