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Updated: Aug 26, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Current trends in heart transplantation
1Division of Cardiothoracic Surgery, Department of Surgery, The University of Illinois at Chicago, Chicago, IL 60612, USA. mmassad@uic.edu
Insights
Heart transplantation has advanced significantly but remains inaccessible globally due to disparities and donor shortages. Future strategies focus on tolerance and selective immunosuppression to improve patient outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Cyclosporin A revolutionized heart transplantation, making it a viable treatment for end-stage heart disease.
- Despite advancements, heart transplantation remains inaccessible to most of the global population, particularly in developing regions.
- Significant disparities exist in heart transplant access and performance between continents.
Purpose of the Study:
- To review the progress and persistent challenges in heart transplantation.
- To highlight the global inequities and donor shortages impacting the procedure.
- To explore emerging strategies for improving heart transplantation outcomes.
Main Methods:
- Review of historical data and current trends in heart transplantation.
- Analysis of global access and resource allocation for organ transplantation.
- Discussion of ongoing research in immunosuppression and tolerance induction.
Main Results:
- Heart transplantation has evolved from experimental to therapeutic, yet donor shortages persist.
- Over 95% of global heart transplants occur in North America and Europe, despite lower population share.
- Persistent complications include infections, rejection, malignancy, and graft coronary artery disease.
Conclusions:
- Heart transplantation faces significant global access barriers and ongoing clinical challenges.
- Emerging strategies like donor-specific tolerance and selective immunosuppression offer future hope.
- Further research is crucial to broaden access and enhance long-term survival and quality of life.
Abstract:
With the introduction of cyclosporin A in the early 1980s, heart transplantation was transformed from an experimental procedure into a successful therapeutic option for patients with end-stage heart disease. Since then, constant progress has extended the benefits of the procedure to an increasing number of patients. Despite all this progress, heart transplantation is not an option that can be offered to the vast majority of the world population, in particular to the over 5 billion inhabitants of underdeveloped or developing countries in the three most populated continents, namely, Asia, Africa and South America. While the North American continent and Europe account for only 17% of the world population, they donate and receive over 95% of the heart transplants performed worldwide. In addition, the number of transplant candidates continues to exceed the number of available donors, and the donor shortage is not expected to improve. Opportunistic infections, rejection, malignancy and graft coronary artery disease continue to plague heart transplantation and remain the Achilles heel of the procedure. With the beginning of the new millennium, new perspectives are arising in heart transplantation. Strategies addressing donor-specific tolerance and the development of selective immunosuppressive therapies are on the horizon and could improve the quality of life after transplantation and also prolong survival.
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