Heart transplantation has now achieved a therapeutic status similar to that of cadaveric renal transplantation. Depending on patient selection criteria, it is estimated that as many as 15,000 people per year could conceivably benefit from a heart transplant, but the actual number of persons who will benefit is severely constrained by donor supply. Availability of heart donors was estimated based on data obtained on 1,955 organ donors in the United States. The results show that because of age and other contraindications, only 400 to 1,100 viable donor hearts may be available each year. Donor supply is the most critical determinant of the future of heart transplantation since it will dictate the number of transplants performed, the survival of transplant recipients, the total program expenditures associated with heart transplantation, the nature of the legal and ethical issues involved, the number of cardiac transplant programs required to make optimal use of the available donor hearts, and the future role of mechanical circulatory support systems.
KIE: In the opinion of the authors, heart transplantation has achieved a therapeutic status equivalent to that of cadaveric kidney transplantation; and they estimate that as many as 15,000 patients per year could benefit from transplants. Based on their analysis of data on 1,955 recent organ donors, however, the authors warn that only 400 to 1,100 donor hearts may be available per year for transplantation. Donor supply is seen as the most critical factor in the development of heart transplantation, and the projected shortfall of organs will affect the number of transplants performed, the number of centers needed to perform them, the survival of recipients, the nature of legal and ethical issues involved, and the role of xenografts and mechanical circulatory support systems.