Honoring 50 Years of Clinical Heart Transplantation in Circulation: In-Depth State-of-the-Art Review

Josef Stehlik, MD, MPH; Jon Kobashigawa, MD; Sharon A. Hunt, MD; Hermann Reichenspurner, MD, PhD; James K. Kirklin, MD


Circulation. 2018;137(1):71-87. 

In This Article

Heart Transplantation From the Global Perspective

During the early 1980s, the need for an organized international forum for the exchange of scientific information to improve patient outcomes provided the stimulus for creating the International Society for Heart Transplantation, later renamed the International Society for Heart and Lung Transplantation. The complex logistics of heart transplantation and the involvement of a wide range of clinicians have contributed to the development of integrated multispecialty teams, a model that has been replicated in many countries. The International Society for Heart and Lung Transplantation International Thoracic Transplant Registry, which receives data from [almost equal to]500 heart transplantation programs in 40 countries, reported a continued increase in the annual number of heart transplantations performed worldwide over the last decade (Figure 8).[18]

Figure 8.

Number of heart transplantations (adult and pediatric) by year and geographic region.
Reproduced from Lund et al19 with permission. Copyright ©2017, Elsevier, Inc.

The number of transplantation candidates placed on waiting lists worldwide typically greatly outweighs the number of available donor organs. In the absence of a reliable prognostic score for stage D heart failure and in combination with the evolving MCS options, it has been difficult to design an organ allocation system that would reliably prioritize transplantation in patients with the greatest need. The recently proposed revisions of allocation systems are intended to readjust some of the current allocation shortcomings.[88,89]

In some instances, transplantation tourism (seeking a transplantation in country other than the recipient's residence) takes place under circumstances of organ procurement and the transplantation process in violation of the ethics standards of the Declaration of Istanbul.[90] Efforts to reduce the need for transplantation tourism should include interventions that increase the rate of altruistic organ donation and enhance the quality of donor management and the efficiency of the transplantation system as a whole.[91] The eventual goal is for all countries to be self-sufficient as far as availability of donor organs for their citizens.