Heart transplantation

The clinical success of cardiac transplantation for patients suffering from end-stage heart failure has led to an increased demand for heart donors. Currently, 1.7% of all patients and 45% of the status 1 patients listed for transplantation die while awaiting a suitable donor organ.1 The availability of donor organs is presently the primary limiting factor to cardiac transplantation. As in the case of abdominal organs, a common approach has been to extend the acceptance criteria for hearts. Donor parameters such as advanced age, high-dose inotropic support, seropositivity for hepatitis C, size mismatch, echocardiographic abnormality, and prolonged cold ischemic time have been reconsidered as relative contraindications to organ usage. Certain criteria such as donor seropositivity for human immunodeficiency virus (HIV), intractable ventricular dysrhythmias, extracranial malignancy, documented prior myocardial infarction, severe coronary artery or valvular disease, and death from carbon monoxide poisoning with a blood carboxyhemoglobin level greater than 20% remain absolute contraindications. Patients are listed according to priority. A large proportion-more than 90% of recipients-are inpatients at the time of transplantation.2