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UK NEEDS FEWER TRANSPLANT UNITS

The number of heart transplant units in the UK should be reduced, due to the lack of transplants being performed and the difficulty for surgeons of maintaining the relevant expertise, according to a study1 published recently online at bmj.com.

Dr Guy MacGowan and colleagues say that, despite a record high number of UK donors available for organ transplants generally, there has been a 46% reduction in heart transplantation rates over the past 10 years.  

Furthermore, this problem seems particular to the UK as international data show rates are steady or only marginally declining in Europe and the United States.

heart-internalOne consequence of this decline is the need for more left ventricular assist devices as an alternative treatment for end-stage heart failure, say the authors.

  “Newer generation devices have survival rates comparable to transplant at one to two years, so could be considered as an alternative in some situations,” they write.

The second consequence of the reduced availability of heart transplants is that it is vital to prioritise patients according to who will probably benefit most. 

The third is that it is difficult for surgeons in the six UK units to maintain their expertise, so the number of units may need to be reduced. This has been recently recognised, and the Department of Health is planning to conduct a review of cardiothoracic transplantation in the UK, say the authors.

They argue that this review “must recognise that the use of long term devices for destination therapy is an essential service that needs to be developed in transplant centres as a consequence of the falling heart transplant numbers, and there needs to be adequate provision of heart transplantation for adults with congenital heart disease and heart failure”.

References

MacGowan GA, Parry G, Schueler S, et al.  The decline in heart transplantation in the UK.  BMJ 2011;342:d2483.

Published on: May 6, 2011

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