The present state of heart transplantation

After more than 25 years, including long periods of scepticism, heart transplantation, with the introduction of several fundamental innovations, has become a routine clinical procedure for treating life-threatening end-stage heart failure. Annually, 3000-4000 transplantations are performed worldwide. Heart transplantation has been performed successfully in patients of almost all ages, from newborn babies with untreatable heart defects to 70-year-olds. Transplant organs are explanted from deceased donors who have suffered brain death. The circulation is kept stable for several hours during which time a well-functioning heart can be excised. In Europe, as a rule, donor organs are matched to recipients by national or multinational organ-sharing organisations. 'Eurotransplant', for example, serves medical institutions in Germany, Austria, and the Benelux states. This enables 500-600 hearts to be transplanted in Germany each year. Since 1986, 650 heart transplantations have been performed at the German Heart Institute Berlin (GHIB) and more than 100 are performed per year. In recent years, heart-lung, single-, and double-lung transplantations have been added to the GHIB's surgical program, accounting for more than 40 operations since the institute's inception. Patients at the GHIB have ranged in age from 8 days to 68 years, including 48 patients under the age of 16 years. Approximately two-thirds of the patients suffered from dilated cardiomyopathy and one-third from coronary artery disease. Smaller groups of patients suffered from valvular or congenital heart disease. Patients were selected for heart transplantation when heart failure was untreatable by other means and when their life expectancy was estimated to be 6 months or less.(ABSTRACT TRUNCATED AT 250 WORDS)