Present status of heart transplantation

Heart transplantation has evolved from an experimental procedure with a low survival rate to a therapeutic option for patients with end-stage heart disease. The most common diagnosis among recipients is cardiomyopathy, followed by coronary artery disease and vascular disease. As immunosuppression techniques have improved and protocols standardised heart transplantation has been successfully employed by many centres. A growing insight into the risks and benefits of cardiac transplantation means that we can stratify an individual patient's risk, thereby enhancing both selection for and timing of transplantation. The number of suitable donors available is limited so we should ensure that donor's hearts go those patients who stand to gain the greatest benefit after operation. The cost-benefit ratio has been shown to be good and heart transplantation is nowadays a routine procedure in cardiac surgery.