Heart transplantation as a treatment modality was conceptualized by Christian Barnard in 1967 . Still considered as an “Act of God” this surgery is regularly performed worldwide by dedicated transplant team consisting of cardiac surgeon , physician , Anesthetist , pathologist and others .Unlike other organs , heart transplant cannot have a “live donor” .Though started half a century ago, the real pace has picked up only in last 2 decades .Currently it is “globally accepted standard” intervention in terminal cardiac failure (Including pediatric heart conditions)
How are the survival rates ?
- Now, many centers are able to reach the bench mark Stanford- statistical rates with a consistent five year survival rate crossing 75% .
- The median survival rates is 10.5 years
- One of the estimate indicate , If they cross first year, median survival reach 13.5 years
- There has been many living survivors who have crossed 30 years.
Looking at these numbers , there is dramatic impact in terms of global disease burden and the life gained.Statistically speaking successful treatment by heart transplant is equivalent to overwhelming many cancers in a human body !
Can these results reproducible in all centers ?
These excellent outcome is the reward to highly dedicated teams with pioneering work culture . One should be cautious to start new transplant center without proper facility and expertise.Unregulated heart transplant centers is vested with risk of pulling down the excellent statistics of this unique form of human organ exchange.
Patient selection criteria and strategies to prevent rejection is being streamlined .The major issue is availability of donor heart and how to optimize organ procurement and increase transport survival time .Transmedics has deviced a state of the art organ transport system . The other exciting thing expected to happen is potential (Ironical though !) heart donors from even cardiac /circulatory deaths . (Dhital KK, Iyer A, Connellan M Lancet. Adult heart transplantation with distant procurement and ex-vivo preservation of donor hearts after circulatory death: a case series.2015 Jun 27;385(9987)
What about artificial hearts ?
As of now biological heart has definite edge over artificial heart.Meanwhile rapid development of LV assist device and near total artificial hearts may end up with destination therapy rather than bridge to transplant. The “INTERMACS ” data are very promising and let us wait for the day artificial heart can score over the biological ones.
1. The Registry of the International Society for Heart and Lung Transplantation: Twenty-eighth Adult Heart Transplant Report–2011.Stehlik J1, Edwards LB, Kucheryavaya J Heart Lung Transplant. 2011 Oct;30(10):1078-94.