Alternate Heart Program

Heart Failure February 1, 2006 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 hearts 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 cant 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 patients 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 recipients blood type and body size. Getting a new organ isnt an easy process. Patients who are the sickest get first priority. And there arent 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 dont 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. AUDIENCE INQUIRY For information about heart failure or other heart diseases: American Heart Association, http://www.americanheart.org or contact your local chapter For general information about heart transplants: Transplant Living, http://www.transplantliving.org United Network for Organ Sharing, http://www.unos.org US Transplant, http://www.ustransplant.org BIBLIOGRAPHY Abouna, G., "The Use of Marginal-Suboptimal Donor Organs," Annals of Transplantation, 2004, Vol. 9, No. 1, pp. 62-66. Conrad, Steven, M.D., Ph.D., "Transplants, Heart," eMedicine, updated August 15, 2004, downloaded from website (http://www.emedicine.com), January 11, 2006. Drummond-Webb, J., et al., "Expanding the Donor Pool," Journal of Heart and Lung Transplantation, May 2004, Vol. 23, No. 5, pp. 639-640. "Heart Disease and Stroke Statistics - 2006 Update," Dallas: American Heart Association, 2006. John, R., "Donor Management and Selection for Heart Transplantation," Seminars in Thoracic and Cardiovascular Surgery, Winter 2004, Vol. 16, No. 4, pp. 364-369. Jury, U., M.D., et al., "Heart Transplant," Circulation, October 1, 2002, Vol. 106, No. 14, p. 1750. Laks, Hillel, M.D., et al., "Use of Two Recipient Lists for Adults Requiring Heart Transplantation," The Journal of Thoracic and Cardiovascular Surgery, January 2003, Vol. 125, No. 1, pp. 49-50. Lietz, Katherine, M.D., Ph.D., et al., "Outcomes in Cardiac Transplant Recipients Using Allografts From Older Donors Versus Mortality on the Transplant Waiting List," Journal of the American College of Cardiology, May 5, 2004, Vol. 43, No. 9, pp. 1553-1561. "Organ Facts," Richmond: Transplant Living, downloaded from website (http://www.transplantliving.org), January 11, 2006. Patel, J., and J. Kobashigawa, "Cardiac Transplantation," Current Opinion in Cardiology, March 2004, Vol. 19, No. 2, pp. 162-165. Pedotti, P., et al., "Analysis of the Complex Effect of Donors Age on Survival of Subjects Who Underwent Heart Transplantation," Transplantation, October 27, 2005, Vol. 80, No. 8, pp. 1026-1032. Research compiled and edited by Barbara J. Fister