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Change of Heart

Heart transplants are a last option for patients with end-stage heart failure, most often due to a heart that has become weaker over time, a blockage or a congenital cause. The number of people who need a heart transplant is increasing as those with heart failure live longer as a result of better treatment options, says Parag C. Patel, division chair of heart failure and transplantation at Mayo Clinic in Jacksonville.

Although the number of people in the U.S. who are on a heart transplantation waiting list still outweighs the number of available hearts, there are trends that are helping with supply and demand, Patel says. This includes the use of an Organ Care System from TransMedics, which can keep a heart supplied with oxygen and nutrients in a special machine until it’s transported to the patient in need.

Nicknamed “heart in a box,” the system expands the time in which a heart can be taken from a donor and then provided to a recipient. Traditionally, transplant centers only have four to six hours in which to transport a heart and provide it to the recipient.

Many transplant centers are also revising their criteria for organ acceptance to try to boost the number of patients who are able to receive a transplant, says Juan R. Vilaro, an associate professor of medicine in the division of cardiovascular medicine and heart transplant medical director at the University of Florida in Gainesville.

The future of heart transplantation will likely include the use of 3-D constructed hearts along with virtual reality to help plan for transplant surgeries, Patel says. Another approach being studied is xeno-transplantation, including the use of hearts from animals like genetically modified pigs. A Maryland patient who received a heart from a genetically modified pig in January 2022 died two months later.

Transplant experts also will continue to look into multiorgan transplantation as an option because a large proportion of heart transplant patients also have significant and chronic renal and liver disease, Vilaro says.

If a patient survives her first year after a heart transplant, the average survival is 15 years, Patel says.