UK Needs Fewer Heart Transplant Units As Number Of Heart Transplants Fall, Say Experts

Academic Journal
Main Category: Cardiovascular / Cardiology
Also Included In: Transplants / Organ Donations
Article Date: 05 May 2011 - 16:00 PST


It is time to consider reducing the number of heart transplant units in the UK because too few transplants are being performed and it is difficult for surgeons to maintain their expertise, argue experts on bmj.com today.

Consultant cardiologist Guy MacGowan and colleagues say that, despite a record high number of UK donors available for organ transplants generally, there has been a 46% reduction in heart transplantation rates over the past 10 years.

Furthermore, this problem seems particular to the UK as international data show rates are steady or only marginally declining in Europe and the United States.

One consequence of this decline is the need for more left ventricular assist devices (mechanical pumps) as an alternative treatment for end-stage heart failure, say the authors.

These devices can be used to support a patient until a suitable heart becomes available or as "destination therapy," where the patient is not considered a suitable candidate for transplantation and receives long term support with the device. "Newer generation devices have survival rates comparable to transplant at one to two years, so could be considered as an alternative in some situations," they write.

The second consequence of the reduced availability of heart transplants is that it is vital to prioritise patients according to who will probably benefit most.

The third is that it is difficult for surgeons in the six UK units to maintain their expertise, so the number of units may need to be reduced. This has been recently recognised, and the Department of Health is planning to conduct a review of cardiothoracic transplantation in the UK, say the authors.

They argue that this review "must recognise that the use of long term devices for destination therapy is an essential service that needs to be developed in transplant centres as a consequence of the falling heart transplant numbers, and there needs to be adequate provision of heart transplantation for adults with congenital heart disease and heart failure."

Freeman Hospital has been shortlisted for the BMJ Group award for Secondary Care Team of the Year for its use of mechanical assisted devices to support patients with advanced heart failure.

Link to editorial

Source
British Medical Journal

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