Selection andprocurement ofhearts fortransplantation T A H ENGLISH,PSPRATT, JWALLWORK, R CORY-PEARCE,D WHEELDON

Thesuccess oforthotopic hearttransplantation depends whollyon satisfactory function ofthenew hearton completion oftheoperation. Thisinturndependson thequality ofthedonorheartbeforeitsremoval,the effectiveness ofthemethodsusedtopreserve itduring transport fromthedonortotherecipient hospital, and theaccuracyoftheoperative procedure. FromJanuary 1979toDecember1983,62 donorheartsweretransplanted into61recipients atPapworthHospital. These hearts wereselected from250offered forconsideration. Themostcommon reasonsfornotproceeding withan initial inquiry werefailure ofthedonortomeetthe medicalcriteria forselection (77cases)and lackof intensive carefacilities orstaffshortages suchthata transplant couldnotbeaccommodatedatthetimeof inquiry(80).Eightearlydeathsoccurred, of which threewereduetoprimaryfailure ofthedonorheart. Actualoneandthreeyearsurvivals forthewholeprogramme were58% and50%respectively, thecurrent actual oneyearsurvival being70%. Fortypercentofpatients selected fortransplantation diedwhilewaitingfora hearttobecomeavailable. Theiraveragesurvival timewas46days. The number of donorheartsreferredfortransplantation dependson publicattitudes towardsorgan transplantation, thewillingness ofdoctors looking after braindeadpatients toseekpermission fromrelatives forthehearttobedonated, andthecooperation oflocal