[Dynamics of heart transplantation lists and anticipated needs]

No other form of therapy, whether medical or surgical, has an impact comparable to heart transplantation on quality of life and survival of the patients with severe heart failure. In the EC and in the USA about 10 patients per million people are transplanted each year. Since Portugal has a population of 10 million, 100 patients should be transplanted each year. However only 8 patients were in fact transplanted in Portugal in 1998, 2 of them at Hospital S. João. We transplanted less than 10% of the predicted needs. We have the second lowest rate of heart transplantation per million people of the 23 European countries with registries of this activity. This is due to structural and organizational deficiencies which, at least in the case of Hospital S. João have a triple nature: the lack of a professional team devoted to severe heart failure treatment and heart transplantation; the lack of infrastructures, namely a heart failure ward and a heart failure outpatient clinic; and thirdly an inappropriate distribution of the tasks associated with heart transplantation and patient follow-up. A prediction of the resources needed for a successful heart transplantation program at Hospital S. João is presented. This was based on what is known regarding the natural history, morbidity and mortality of severe heart failure, on our own experience in this field, and finally on the experience of a large Spanish heart transplantation centre. The recommendations of the British Transplantation Society and those of the Department of Cardiothoracic Surgery of Stanford were also taken into account.