[Political and economic aspects of heart transplantation]

Organ transplant, like any other area of modern medicine, has manifold implications for human values and ethics, while sociology, law, economics and politics are equally involved. A brief review is presented of the political and economic aspects of cardiac transplantation, covering a short overview of current Swiss legislation, the problem of organ allocation, limitation of transplant centres, restriction of transplant medicine to public hospitals, cost of transplant procedures and subsequent treatment, and costs generated by alternative options such as ventricular assist devices. Current transplant medicine is affected by a growing shortage of organs, despite the fact that organ transplantation is generally well accepted by the public. On the other hand, the steadily growing disproportion between the number of organs available and the overall number of potential recipients is a source of concern for transplant surgeons and the medical profession, as well as the community at large. To be able to face these significant problems, transplant centres should offer all aspects of treatment for heart failure. In particular, before cardiac transplant is offered to a patient, all aspects of more conservative treatment should be exhaustively discussed. The economic aspects of each type of transplantation are usually discussed, but the cost of a transplant procedure should be compared with that of conventional treatment. The increasing use of all currently available options (including mechanical and antiarrhythmic bridging) makes a critical confrontation with the economic implications necessary. Assumptions based on current literature suggest that heart transplant generates additional costs of approximately CHF 50,000 per year of extended life. The treatment of heart failure involves additional costs of CHF 20,000 per year, provided only a few hospitalizations are necessary. CHF 80,000 of the cost of a heart transplant is refunded. Medical treatment in the first year after transplant mainly includes immunosuppressive drugs, antibiotic and antihypertensive medication, involving additional costs of CHF 20,000. The future will require complete use of all conventional treatment modalities, recipient selection, strengthened social rehabilitation and a quality control database, as well as consensual recommendations and coordination in research, follow-up and basic treatment.