Heart Transplant (cont.)
Michael C. Fishbein, MD
Michael C. Fishbein, MD
Dr. Fishbein received his undergraduate and medical degrees from the University of Illinois. He completed a residency in anatomic and clinical pathology at Harbor General Hospital/UCLA Medical Center. He is board certified in anatomic and clinical pathology.
In this Article
Who needs a heart transplant?
Every year in the United States there are about 4,000 people who could benefit from a heart transplant. Unfortunately, there are only about 2,000 donor hearts available. Therefore, there is a careful selection process in place to assure that hearts are distributed fairly and to those who will benefit most from the donor heart. The heart is just a pump, although a complicated pump. Most patients require a transplant because their hearts can no longer pump well enough to supply blood with oxygen and nutrients to the organs of the body. A smaller number of patients have a good pump, but a bad "electrical conduction system" of the heart. This electrical system determines the rate, rhythm and sequence of contraction of the heart muscle. There are all kinds of problems that can occur with the conduction system, including complete interruption of cardiac function causing sudden cardiac death.
While there are many people with "end-stage" heart disease with inadequate function of the heart, not all qualify for a heart transplant. All the other important organs in the body must be in pretty good shape. Transplants cannot be performed in patients with active infection, cancer, or bad diabetes mellitus; patients who smoke or abuse alcohol are also not good candidates. It's not easy to be a transplant recipient. These patients need to change their lifestyle and take numerous medications (commonly more than 30 different medications). Hence, all potential transplants patients must undergo psychological testing to identify social and behavioral factors that could interfere with recovery, compliance with medications, and lifestyle changes required after transplantation.
Moreover, needing a heart and being a suitable candidate are not enough. The potential donor heart must be compatible with the recipient's immune system to decrease the chance of problems with rejection. Finally, this precious resource, the donor organ, must be distributed fairly. The United Network for Organ Sharing (UNOS) is in charge of a system that is in place to assure equitable allocation of organs to individuals who will benefit the most from transplantation. These are usually the sickest patients.