Impact of Medical Treatment on Heart Transplantation
Has the need for or number of heart transplants performed in the United States and Europe decreased due to better medical treatment of the patient with heart disease?

Tihomir Kekez, MD

I believe there are 2 answers to this question. First of all, there is no question that heart failure therapy has significantly improved survival in this patient population. Beta-blockers, angiotensin-converting enzyme inhibitors, spironolactone, and automatic internal cardiac defibrillators have all contributed to improved survival. In fact, there is growing controversy as to whether a Status II patient (waiting at home) on the heart transplant waiting list even needs to be transplanted.

The second answer is that the number of donors has been decreasing, as noted by the increasing average age of the donor pool. This will also limit the number of transplants, as almost all donor hearts are being used, especially with "alternate list" transplant programs that use marginal hearts (usually older donor hearts) mostly for older candidates. Motorcycle helmet laws and reduced speed limits have decreased the donor pool, especially in the younger donor population. Therefore, better heart failure therapy and fewer available donors have contributed to a lower number of heart transplant surgeries in Europe and the United States.