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Review of the Global Activity of Heart Transplant
Abdelghani El Rafei1, Rebecca Cogswell2, Fernando A Atik3
1Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (A.E.R., L.A.A.).
Insights
Heart transplantation (HT) is a vital treatment for end-stage heart failure, but global access remains unequal. Addressing challenges like funding and organ supply is crucial for expanding HT worldwide.
Area of Science:
- Cardiology
- Transplantation Medicine
- Global Health
Background:
- Heart failure presents a significant global health burden with substantial morbidity.
- Heart transplantation (HT) offers a life-saving therapy for eligible patients with advanced heart failure.
- Global HT rates are concentrated, with 90% performed in the US and Western Europe.
Purpose of the Study:
- To provide a comprehensive overview of the global landscape of heart transplantation.
- To explore the challenges and prospects of HT practices worldwide.
- To identify factors limiting HT expansion and opportunities for improvement.
Main Methods:
- Review of global HT practices, rates, and post-transplant outcomes.
- Analysis of regional and country-specific differences in HT accessibility.
- Examination of barriers such as sociocultural factors, healthcare funding, socioeconomic disparities, and organ availability.
Main Results:
- Significant disparities exist in HT rates and outcomes globally.
- Key limitations include sociocultural factors (Japan, Israel), healthcare funding (India, South Africa), access disparities (USA), and organ shortages (China, Saudi Arabia).
- The majority of HTs are performed in high-income regions, with limited access elsewhere.
Conclusions:
- Addressing multifaceted barriers is essential to enhance global HT accessibility.
- Opportunities exist to improve HT availability, particularly in lower- and middle-income countries.
- Collaborative efforts are needed to overcome challenges and expand life-saving heart transplant therapies worldwide.
Abstract:
Heart failure is a global disease with significant morbidity. Heart transplant (HT) can be a lifesaving therapy for select patients with end-stage heart failure. In 2020, over 7000 HTs were performed globally; 90% of HTs were performed in the United States and Western Europe, with only 10% throughout the rest of the world. In this article, we offer an overview of the global landscape of HT, exploring challenges and prospects worldwide. We review HT practices, rates and post-HT outcomes, underscoring the differences between countries within each region. We review limitations hindering HT expansion, such as sociocultural factors, as seen in Japan and Israel; health care funding, in countries like India and South Africa; socioeconomic disparities in access, like the United States; and shortage in organ supply, as seen in China and Saudi Arabia. This review underscores the need to address limitations and highlights opportunities to enhance global HT accessibility, especially in lower- and middle-income countries.
