The alternate recipient list for heart transplantation: does it work?

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.