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The alternate recipient list for heart transplantation: does it work?
H Laks1, F G Scholl, D C Drinkwater
1Division of Cardiothoracic Surgery, University of California, Los Angeles, USA.
Insights
The alternate recipient list for heart transplantation offers a valid option for patients who might otherwise be denied. This approach provides similar outcomes to the standard list, utilizing organs that may otherwise go to waste.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Outcomes
Background:
- High mortality rates for patients awaiting heart transplantation due to organ shortages.
- Development of an alternate recipient list for patients over 65 or needing a third transplant.
- Utilizing marginal donor organs for patients who would otherwise be denied transplantation.
Purpose of the Study:
- To evaluate the efficacy and ethics of the alternate recipient list for heart transplantation.
- To compare outcomes of patients on the alternate list versus the standard waiting list.
- To assess the utilization of marginal donor organs.
Main Methods:
- Retrospective analysis of 22 patients on the alternate recipient list (1991-1996).
- Comparison of 17 transplanted patients from the alternate list with 266 patients from the standard list.
- Evaluation of early mortality and actuarial survival rates.
Main Results:
- Early mortality for the alternate group was 11.8% (2/17) versus 5.6% (15/266) for the standard group.
- Actuarial survival at 6 months and 1 year was 74.5% for the alternate group.
- Actuarial survival at 6 months and 1 year was 86.8% and 83.1% for the standard group, respectively.
- No significant difference in early mortality or survival between the two groups.
Conclusions:
- The alternate recipient list is a valid and ethical option for heart transplantation candidates.
- Patients on the alternate list experience similar early and medium-term outcomes compared to the standard list.
- The alternate list facilitates the use of donor organs that might otherwise be wasted.
Background:
One quarter of patients awaiting heart transplantation die while on the waiting list. This is largely due to the shortage of donor organs. The alternate recipient list was created to establish a means by which patients who would otherwise be turned down for heart transplantation solely because of age over 65 or a need for a third heart transplantation can receive organs considered marginal that may otherwise be wasted. The hope is that these patients may achieve improved survival with these substandard hearts than they would achieve with medical therapy alone.
Methods:
Twenty-two patients ages 47 to 71 years (mean 66.7 years) were listed on the alternate recipient list at the University of California at Los Angeles Medical Center from 1991 to 1996. Seventeen patients underwent heart transplantation from the alternate waiting list. The outcome of this group was compared with the outcome of a contemporaneous group of 266 patients ages 18 to 66 years (mean age 52.1 years) from the standard heart transplantation waiting list.
Results:
The early mortality rate for the patients in the alternate group was 11.8% (2/ 17). Actuarial survival from time of orthotopic heart transplantation at 6 months and 1 year was the same 74.5% at a mean follow-up was 13.4 months. In comparison, the early mortality rate for the patients on the standard list was 5.6% (15/266), and actuarial survival at 6 months and 1 year was 86.8% and 83.1%, respectively (mean follow-up was 30 months). There was no significant difference in early mortality rate or actuarial survival between the two groups.
Conclusion:
The alternate recipient list for heart transplantation is a valid and ethical option for patients who would otherwise be denied heart transplantation. It provides these patients with similar early and medium-term outcomes in comparison to patients on the standard list, and organs that may otherwise be wasted are used.