The transplantation heartache

December 3, 2007

The transplantation heartache

By Clare Murphy
Health reporter, BBC News

It is 40 years since the first heart transplant was carried out by Dr Christiaan Barnard in Cape Town, South Africa.

Barnard and his team
What would Barnard say about transplantation today?

Admittedly, his patient lasted little longer than two weeks, but a huge medical advance had been made. Yet 40 years on, are we still advancing?

Well, here in the UK, not exactly.

Heart transplantation in this country was at its peak about a decade ago. Then, over 350 such operations were carried out each year.

Last year, less than half that number were performed.

Dying differently

It is not all bad news. New techniques mean people with imperfect hearts can go longer without, potentially, ever needing a transplant.

WAITING LIST 2006-2007
307 people on it at some point
28 died waiting for a heart
32 removed from list as too ill

But without a doubt the figures also reflect a fall in the number of viable organ donors, even though the number of people registering themselves as organ donors continues to climb.

One of the problems – from the heart patient’s perspective – is that we are simply are not dying like we used to.

Road accidents used to provide a rich seam of organs. Victims are usually healthy, often young, and the injuries sustained tend to be the head, not to other parts of the body.

But safety campaigns have had an impact, and the number of traffic deaths has fallen dramatically, seriously impinging on the number of organs available.

One year: 80%
Five years: 70%
Ten years: 53%

While the typical donor used to be a 20-year-old man who had fallen off his motorbike, now he is much more likely to be a 55-year-old who smoked.

Less than perfect organs can be "repaired", but the situation is not ideal.

Papworth Hospital, where the first ever NHS transplant was carried out in 1979, was recently given the all-clear following an inquiry into why seven out of 20 patients treated this year who died within 30 days of surgery.

Many random factors may have been involved, but the deaths did raise questions about the quality of organs currently being donated.

Ill and waiting

The commission which investigated the deaths also stressed that those being operated on were "extremely ill" to begin with.

I used to be operating on people who might still have years to live, but shortages now mean that only people in an absolutely critical condition are offered organs
Professor John Dark

But this in itself is a shift from the past.

"I used to be operating on people who might still have years to live, but shortages now mean that only people in an absolutely critical condition are offered organs," says Professor John Dark, a heart surgeon who works at the Freeman Hospital in Newcastle.

"The waiting list has fallen, but out of practical necessity. People who would once have gone on the list just don’t get put on it anymore. We deal only with the very, very sick."

Last year there were 307 people who at some point were on the waiting list. Of these, 28 died while waiting for a heart, and a further 32 were removed from the list because they were too ill to undergo treatment.

"You can add these last numbers to the people who died waiting, because that’s essentially what happened to them," a spokesman for UK Transplant said.

What now?

Back in the 1990s, even when human hearts were being donated at a relatively healthy rate, there was much faith in the pig as the organ donor of the future.

We heard talk of "organ farms" where genetically-engineered pigs would be reared and provide a virtually limitless supply of hearts, livers and kidneys.

Yet the project became fraught with the old problems of rejection and viral transmission. We were not quite as like pigs as we thought.

Other non-human alternatives have been slow to develop, but many experts believe the mechanical pump, which is moderately successful at the moment, still holds out the most hope.

Technical issues need to be overcome, but with the will and enough money, a fully effective version could be with us in the foreseeable future.

At the same time stem cells, which have yet to deliver on great promises, could one day grow us hearts in laboratories.

But at the moment there is nothing that beats the human heart.

The UK government is currently looking into turning our current system of "opting in" to being a donor, to "opting out", where everybody is considered a donor unless they explicitly state otherwise.

But this is a thorny issue, and there are some who believe that no matter how many people are dying on waiting list, the suggestion that the state presume control of our bodies is one step too far.

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