Heart and Lung Transplant
Francisco Talavera, PharmD, PhD
Heart and Lung Transplant Overview
A pioneering heart surgeon, Dr Christiaan Barnard, performed the first successful human-to-human heart transplant operation in 1967 in Cape Town, South Africa. Unfortunately, early operations resulted in problems such as infection and rejection, and heart recipients did not survive very long.
With advances in technique and development of new drugs to suppress the immune system, more than 70% of transplant recipients currently survive more than 3 years. The problem now is a severe shortage of donor hearts in the United States. Each year, thousands of people are waiting for a heart. About 35% of them die before a heart becomes available. Only about 2,000 heart transplants are done each year in North America, the major reason is lack of donors.
- A "bridge" device (assisted device) has been developed that lets certain people live longer while they wait for transplantation. A balloon pump inserted into the aorta, along with battery generator device, that can help the heart to provide blood flow to the body. This “bridge” cannot be used for long and used only in people who are critically ill and very close to getting a new heart.
- A newer procedure involves implanting a mechanical pump into your body to help pump the blood. This pump, called a left ventricular assist device (LVAD), can be used for months or even years. It cannot be used indefinitely.
- Total artificial hearts are now available and have been implanted in a few patients. Besides costs, complications are still present.
Successful lung transplantation has been performed since the early 1980s. The first surgeries involved transplanting both lungs and the heart together. Since then, operations have been developed to transplant both lungs, a single lung, and even partial lung (lobes).
Because of the severe shortage of organs, combined heart and lung transplants are rare (less than 20 per year are done in North America).
- With improved surgical techniques and powerful medicines to prevent rejection, life expectancy after transplantation has increased over the last 2 decades.
- Just as with heart transplantation, demand for donor lungs is greater than the supply. In 1998, 3144 people were on the waiting list for a lung transplant; 498 (16%) died before getting a donor organ. In the United States, people may wait 18 months or longer for a donor lung.
Because of such demand, systems have been developed to make sure that the sickest people are first to receive donor organs. Donors are carefully screened to make sure that only healthy lungs are transplanted. Because of the severe shortage, bilateral lung transplants are rare. Most patients receive a single lung.