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Review
. 2016 Apr;9(4):e002679.
doi: 10.1161/CIRCHEARTFAILURE.115.002679.

Matching the Market for Heart Transplantation

Eileen M Hsich  1
Affiliations
Review

Matching the Market for Heart Transplantation

Eileen M Hsich. Circ Heart Fail. 2016 Apr.

Abstract

Heart transplantation is the most effective therapy for patients with Stage D heart failure with a median life expectancy of ≈10 to 15 years. Unfortunately, many patients die on the waiting list hoping for a chance of survival. The life boat cannot rescue everyone. Over a decade, the donor pool has remained relatively stable, whereas the number of heart transplant candidates has risen. Potential recipients often have many comorbidities and are older because the criteria for heart transplantation has few absolute contraindications. Women, Hispanics, and patients with restrictive heart disease and congenital heart disease are more likely to die while awaiting heart transplantation than men, white patients, and those with either ischemic or dilated cardiomyopathy. To better match the market, we need to (1) increase the donor pool, (2) reduce the waitlist, and (3) improve the allocation system. This review article addresses all 3 options and compares strategies in the United States to those in other countries.

Keywords: health care; heart disease; heart failure; transplantation; ventricular assist device.

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Figures

Figure 1
Figure 1
Organ Donation Registration and The Impact of Facebook Organ Donor Initiative. On May 1, 2012 Facebook launched to 30% of their customers a Facebook “Timeline” platform that included organ donor designation. At that site one could link to educational information and state registration. Upon registering, potential donor's “network of friends” was notified of the change in status. Figure A. Graphs the Facebook Initiative and the effect on new online registration compared to those who were already an organ donor at time of Facebook usage. Figure B. Compares the effect of online Facebook registration to Department of Motor Vehicle registration. Copied from Cameron et al.
Figure 2
Figure 2
Interaction between Donor Left Ventricular Hypertrophy and Ischemic Time on Post-Transplant Survival. Copied from Wever Pinzon et al
Figure 3
Figure 3
Cardiac Transplant Research Database: Adults Heart Transplantation and the Effect of Donor Hypertension (A) or Diabetes Mellitus (B) and Gender. The cohort consists of 7,322 patients from 32 heart transplant centers who were transplanted between 1990-2007. Copied from Stehlik et al
Figure 4
Figure 4
Scientific Registry of Transplant Recipients: Total Patients Awaiting and Receiving Heart Transplantation from 2002-2013. Adapted from Colvin-Adams et al
Figure 5
Figure 5
Scientific Registry of Transplant Recipients: Mortality on Waiting List For Heart Transplantation from 2002-2013. Figure A. Mortality stratified by UNOS Status. Figure B. Mortality stratified by presence of a ventricular assist device. Adapted from Colvin-Adams et al
Figure 6
Figure 6
Scientific Registry of Transplant Recipients: Gender Differences in Survival on Heart Transplant Waiting List from 2000-2009. Adapted from SRTR data
Figure 7
Figure 7
Scientific Registry of Transplant Recipients Between 2000-2010: Survival on Heart Transplant Waiting list based on Type of Cardiomyopathy. Copied from Hsich et al
See this image and copyright information in PMC

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