Elderly men and women with heart failure and men with treated prostate cancer are among those who have been historically denied heart transplantation. // Now, under new guidelines co-authored by a Hopkins cardiologist and issued today by the International Society for Heart and Lung Transplantation (ISHLT), they can and should be considered.
“People who once would die because they did not qualify now have a chance to get a new heart,” says Stuart Russell, M.D., who served on the ISHLT committee revising the guidelines.
“Research now suggests they are actually good candidates,” he adds.
ISHLT guidelines, which date back to 1992 and were last updated in 1997, restricted access for cancer patients who been tumor free for less than five years or had weakened immune systems from cancer therapy that precluded them from taking anti-rejection drugs for a transplanted organ.
The new recommendations allow some people with slow-growing or treated cancers to qualify, and they raise the qualifying age cap from 65 to 70.
Support for the new criteria, says Russell, comes from research confirming that transplant recipients over age 65 have a 90 percent survival rate one year post-transplant. After 10 years, he says, 50 percent are still alive.
“Too often, people suffering from heart failure and cancer give up on the prospect of a long, productive life, thinking they have exhausted all treatment options possible, and even their primary physicians are not aware that transplantation is a viable option,” says Russell, an associate professor at The Johns Hopkins University School of Medicine and its Heart Institute. Russell has been personally involved in the care of more than 360 heart transplantation patients, including 13 at Hopkins so far in 2006 and another 18 in 2005. He began work on revising the guidelines at the April 2005 annual meeting of the ISHLT.
The expanded criteria follow changes in 2
002 guidelines for organ donation, which permitted transplantation of hearts from those over 50, even when the hearts were enlarged or the arteries feeding it were clogged, provided the clot was removed. And they are likely to increase demand for already scarce donor organs.
As of Sept. 1, at least 2,885 Americans were on waiting lists for a heart transplant, according to the latest figures from the United Network for Organ Sharing, the international coordinating body that impartially distributes donated organs. Up to 20 percent of those on the list to receive a heart will die while waiting, Russell notes.
The guidelines reaffirm the organization’s view that demand for transplantations is unlikely to ever be fully met and that more resources are needed to slow down the progression of heart failure and prevent the need for transplant surgery in the first place.
Russell says new drugs, implantable defibrillators and pacemakers, and smaller heart pumps can assist a weakened heart for longer periods, or until a donor new organ becomes available.
He estimates that the relaxed guidelines could result in up to 15 more heart transplantations for patients in the region served by Hopkins in southeastern Pennsylvania, Maryland and northern Virginia, none of whom would have qualified for an organ under the old restrictions. Nationally, he estimates, up to 400 more patients could now qualify and receive a new heart.
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