Call for fewer UK heart transplant units as transplant rates decline
MedWire News: The rate of heart transplantation has declined in the UK over the past decade, which researchers believe must lead to fewer heart transplant units, and increased use of left ventricular assist devices.
Writing in the BMJ, editorialists Guy MacGowan and colleagues (Freeman Hospital, Newcastle upon Tyne, UK) say that although a record high number of UK donors available for organ transplants has been reported, heart transplant rates have declined by 46% over the past ten years. Furthermore, this problem has only been seen in the UK, leading some to suggest that the reduction could be due to the small number of intensive care beds in the country.
As a result, MacGowan et al state, the use of left ventricular assist devices needs to be increased. Because the survival rates produced by newer generation devices are comparable to transplant at 1-2 years, they could be used as either a "bridge to transplantation," to support a patient until a suitable heart becomes available, or as "destination therapy" in patients not suitable for transplantation.
Secondly, they say, patients should be prioritized according to need for the few transplant operations available.
The authors point out that the number of units performing heart transplants may also need to be reduced, so that surgeons are able to maintain their expertise. The Department of Health will conduct a review of cardiothoracic transplantation in the near future.
The authors conclude: "This review must recognize that the use of long term ventricular assist devices for destination therapy is an essential service that needs to be developed in transplant centers as a consequence of the falling transplant numbers, and that there needs to be adequate provision of heart transplantation for adults with congenital heart disease and heart failure."
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By Piriya Mahendra