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Cardiac transplantation: the alternate list and expansion of the donor pool

Patel, Jignesh; Kobashigawa, Jon A.

Current Opinion in Cardiology: March 2004 - Volume 19 - Issue 2 - p 162-165
Heart transplantation

Purpose of review Advances in immunosuppression and surgical techniques have allowed cardiac transplantation to become a viable option and the treatment of choice for select patients with end-stage heart failure. The success of the procedure has, however, led to a discrepancy between the number of donors available and the number of patients awaiting cardiac transplantation. As wait times for heart transplant recipients increase, nonstandard donor hearts are increasingly being used for higher risk recipients and critically ill (Status I) patients. We review the development of two recipient lists as a way to provide cardiac transplantation as an option to recipients who would be otherwise ineligible, and determine its impact on expanding the donor pool. Other methods of expanding the donor pool are also reviewed.

Recent findings The alternate list appears to be successful in offering transplantation to patients (mostly older patients) who would not normally be eligible for this life-saving procedure. The alternate list (by changing donor organ acceptance criteria) and ongoing programs to increase organ donation have helped to expand the donor pool.

Summary The donor organ shortage will continue as an increasingly older population develops end-stage organ disease. Expanding the donor pool by a variety of methods will be essential to extend the lives of these patients.

David Geffen School of Medicine at UCLA, Division of Cardiology, Los Angeles, California, USA

Correspondence to Jon A. Kobashigawa, MD, 100 UCLA Medical Plaza #630, Los Angeles, CA 90045, USA

Tel: 310 206 3276; fax: 310 794 1211; e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.