Canada's shortage of hearts for transplantation has reached crisis proportions, the coauthor of the Canadian Cardiovascular Society's Consensus Document on Cardiac Transplantation says.
“Heart transplant rates in Canada have been steady over the past decade at 160–180 a year,” says Dr. Heather Ross, a transplant specialist at the Toronto General Hospital, “but conservative estimates show that we [perform transplants in] only 5% to 10% of those who may benefit from the procedure.” About half of the most desperate patients — those on a transplant waiting list — never receive the operation because of the shortage.
Ross, who presented the consensus document during the Canadian Cardiovascular Congress in Halifax last fall, (www.ccs.ca/, click on Consensus Conferences), said as many as 5000 Canadians could benefit from a heart transplant, and the number is increasing rapidly. (There was a 21; increase in the number of patients on the heart transplant waiting list in 1999, but the number of donors grew by only 6%. In Canada the organ-donation rate is 15.4 per million people, compared with a US donor rate of 28 per million.)
The document notes that the organ shortage continues “despite expanded acceptance criteria for donor hearts” and increased use of “marginal donors,” particularly older ones. The report warns that increasing donor age is associated with poorer short- and long-term survival and that donors older than 50 “should be carefully selected,” with coronary angiography used where indicated.
The document is not optimistic about what the future holds for heart transplantation. “Even with optimal organ donation, including strategies such as ‘presumed consent,’ use of more marginal donors, and institutional and donor family incentives, many believe there will still not be enough organs to meet the need or demand.”
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