Jewish World Review July 30, 2002 / 21 Menachem-Av, 5762

Panel: Ease restrictions on donor hearts

By Peggy Peck | (UPI) A panel of experts on Tuesday will recommend easing restrictions on donor hearts intended for transplantation as the only way to meet the growing need for heart transplants.

The recommendations, hammered out during meetings with representatives of the American Heart Association, the American College of Cardiology, and the United Network for Organ Sharing, will be published in the July 30 issue of Circulation, Journal of the American Heart Association.

Under the new criteria, a heart from a donor over age 55 could be accepted for transplantation as long as "the heart itself was basically healthy," Dr. Jonathan G. Zaroff of the University of California, San Francisco, who co-chaired the panel making the new recommendation, told United Press International.

Likewise, Zaroff said, the panel will urge hearts that have not undergone cardiac cathertization -- a procedure to check for hardening of the arteries -- be deemed transplantable as long as the donor had no history of heart disease.

The new guidelines also urge surgeons to fix minor defects in donor hearts -- such as malfunctioning valves -- by doing "bench repairs" before implanting the overhauled heart in the recipient.

For decades demand for transplantable hearts always has outpaced the number of the organs available, Zaroff said, but in recent years demand has increased to about 8,000 patients while the number of actual heart transplants has "held fairly steady at about 2,500 a year."

A heart becomes available for transplant when a person is declared "brain dead," meaning there is no evidence of electrical activity in the brain. The strict selection criteria now in place mean only about 39 percent of the hearts that become available for transplant actually are transplanted. Often, hearts are rejected because the donor is too old -- over age 55 -- or because certain tests such as cardiac catheterization, which gives detailed images of the veins and arteries inside the heart, are not performed.

Dr. Randall Starling, director of medical care at the transplant unit at the Cleveland Clinic Foundation, said his institution already follows several of the panels' recommendations. The clinic is the number one transplant center in the nation. Starling told UPI, however, the clinic does not concur with one of the new recommendations -- the panel's suggestion that surgeons consider transplanting hearts from persons infected with either hepatitis B or hepatitis C, as long as the would be recipient is similarly infected.

This would be a bad idea, Starling said, because "there are multiple genotypes with hepatitis C and if you are transplanting one genotype into a patient infected with another genotype, you could get some serious infection developing." Starling said he speaks from experience in this matter. The Clinic experimented with this approach only to abandon it when it discovered "about 20 percent of recipients develop serious infections."

Hepatitis C, a chronic condition that can lie dormant for decades, can lead to progressive liver disease including cirrhosis and liver cancer.

Dr. Howard Eisen, medical director of the heart transplant unit at Temple University Medical Center in Philadelphia, said he agrees the new guidelines will need to be approached cautiously, but added he welcomes the easing of restrictions on organ use. One reason is his worry about skyrocketing demand and a diminishing pool of available organs.

"We have an epidemic of heart failure in this country so the need for new hearts is only going to escalate," Eisen told UPI. But he noted fewer hearts are becoming available for transplant because "there has been a significant decline in both traumatic head injuries and in crime. These traditionally have been the source of brain dead donors. But with more people wearing seat belts and helmets, combined with less crime, we have fewer traumatic head injuries."

At the same time transplant experts are urging the use of less-than-prime hearts, the American Medical Association, the American Transplant Congress, and the United Network for Organ Sharing all are urging a pilot study to find out if financial incentives could increase organ donations. The incentive plans would pay a nominal amount, for example $500, toward medical or burial expenses to surviving relatives of a potential donor.

Zaroff, who declined to offer an opinion about financial incentives, pointed out Federal law prohibits the use of financial incentives, so it would take an act of Congress to attempt a pilot study.

In contrast, the new guidelines are likely to take effect "almost immediately as the organ procurement organizations begin to use new procurement forms that will reflect these changed criteria."

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© 2002, United Press International