The latest webinar in the HeartBrothers Foundation’s Heart Failure Awareness Campaign featured Dr. Michael Givertz, director of the Heart Transplant and Mechanical Circulatory Program at Brigham and Women’s Hospital, talking about end-stage heart failure mitigation and transplantation, and Craig Tucker of New England Donor Services talking about the organ donation process.
Givertz started by listing the signs of advanced heart failure, including the following:
● Intolerance to medication
● Need for high-dose diuretics
● Malnutrition and weight loss
● Worsening kidney function
● Repeat hospitalizations
“We just can't keep these patients out of the hospital,” Givertz said. “They keep coming back with worsening heart failure.”
Givertz gave a brief history of heart transplantation, beginning with a Russian doctor in the 1950s who did heart transplant experiments on dogs. In 1976, doctors in South Africa performed the first human heart transplant in a middle-aged man with end-stage heart failure. That patient died quickly of an infection, but a second patient lived nearly two years.
By the late ‘70s, patients were living longer, and with the introduction of prednisone and cyclosporine in the 1980s, “outcomes improved dramatically,” Givertz said.
Over the last 8-10 years, the number of heart transplants has gradually increased. In 2022, more than 4,000 were performed in the United States.
One reason for the increase is the opioid epidemic. “As drug deaths soar, there is a silver lining for transplant patients,” Givertz quoted from a New York Times article. “The surge in deaths from drug overdoses has become an unexpected lifeline for people waiting for organ transplants.”
Another advancement is the use of hearts from donors with Hepatitis C. “We have antiviral medications approved by the FDA,” Givertz said. “Research shows that by instituting Hep C therapy along with immunosuppression, the virus went away within two weeks in all our patients. It is now a standard of care.”
Givertz said hearts from donors with COVID can also be used.
The introduction of the so-called “heart in a box” has increased the availability of donor hearts from farther distances. This invention re-animates hearts from deceased patients and perfuses them with warm donor blood, keeping them healthy for many hours.
“For more than 40 years, we relied on ice storage. Now we have newer techniques,” Givertz said.
So what are the outcomes post-transplant? “The results are excellent, but we can always do better,” said Givertz.
The five-year survival rate is 75%. “More than half of our patients are living 10 years, if not many more years after that,” he said.
The longest-living transplant survivor was transplanted in 1981.” She did have a second heart transplant in 2005, but has lived more than 40 years with two heart transplants.”
Givertz warned that even after a successful transplant, patients need to be vigilant.
“Coronary artery disease can develop,” he said. “Patients take immunosuppressants every day but they can still develop rejection. And they need to be monitored for skin and other cancers due to chronic immunosuppression.”
New England Donor Services
Craig Tucker with the organ procurement organization (OPO) New England Donor Services spoke about the complexity of organ donation and how the process works. He explained that an OPO is responsible for coordinating deceased organ transplants by making sure that organs can be safely recovered and transplanted into recipients.
“It begins with a patient who needs a transplant and the center that may evaluate [them] for a transplant. There’s organ procurement—finding a potential donor and offering that heart to a transplant center. Then recovering the organ, and the actual transplant.”
Tucker described the kinds of tests done on organ donors, including blood work, cardiac enzymes, EKGs and echocardiograms. “We need to find out if the heart is going to be the right heart for a potential recipient. We provide as much information as we can.”
All the results are immediately uploaded into a database, where doctors can see them in real-time. “That’s essential to make sure the right organ is chosen for the recipient,” Tucker said. “Then the transplant center will decline or accept the organ offer.”
Tucker agreed that recent advancements are leading to more donor organs and transplants.
“With machine perfusion and advancements in the utilization of hearts with hepatitis, we are looking at donors now that we didn’t consider two or three years ago. We are increasing the number of donors we’re evaluating for transplantation.
‘We need to learn more’
Givertz expressed optimism that more progress will be made in the transplant field.
“Successes are slow, I’m going, to be honest. Over the decades, yes, things have gotten better, but they’re not dramatic. We haven’t made huge strides. One of the constant messages we try to get across is the need to learn more. We need to do more clinical studies to determine what are the best medicines to really promote longer-term excellent health.”
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