Combined heart failure transplant program: advantages in assessing medical compliance

Compliance, motivation, and strong family support have been identified as important factors to the success of heart transplantation. Approaches to psychosocial evaluations determining suitability of candidates vary among transplant centers. Although testing, interviewing, and retrospective analyses of patient profiles are valuable, they do not allow for longitudinal evaluation of patients who have been denied transplantation under these standard methods of assessment. The Utah Cardiac Transplant Program (UCTP) combines heart failure and transplant services to provide maximum conventional and experimental therapy to patients with end-stage cardiac dysfunction. A single medical team provides care to all patients. From March 8, 1985 to November 1, 1986, UCTP evaluated 170 patients, assigning 57 to conventional medication therapy, 72 to experimental medication therapy, and 41 directly to heart transplantation. Of the 72 patients assigned to experimental therapy, 21 were subsequently assigned to heart transplantation. In the initial evaluation of four patients, it was determined that they did not have adequate family support or emotional stability to undergo transplantation. After monitoring these four patients through a drug study, it was found that the initial evaluation was incorrect, as the patients demonstrated the ability to adhere to a complex regimen involving multiple diagnostic tests, clinic visits, and medication therapy. Three of these patients subsequently underwent successful transplantations and are alive with a mean follow-up time of 212 days. In conclusion, combining all modalities of treatment for end-stage heart disease into one unified program has definite advantages that include longitudinal evaluation of patients previously denied transplantation.