When a cardiologist has a patient who meets the stringent standards of heart transplantation, it is only natural to wonder who gets a heart transplant. This is a question that everyone on the wait list or about to enroll in a heart transplant program will ask all the way up to the date of transplantation.
UNOS and OPTN are the public-private entities that are mandated by federal law to administer the awards of transplant organs. OPTN maintains a record of every patient in transplant programs. The agency uses information provided by cardiologists to keep a record of each patient and the data that is used to determine who gets a heart transplant.
The first step in heart transplantation is to be admitted to a transplant center. The selection of the center encompasses a number of factors that the patient must evaluate.
The basic criteria for consideration by a program include the Ejection Fraction or amount of blood distributed by each heartbeat and the VO2, or the amount of oxygen needed by the body. In my case, the Ejection Fraction was slow to deteriorate to heart transplant status, but my VO2 was always at transplant levels. You may often hear transplant patients say they suddenly had difficulty tying their shoes or climbing upstairs, a horrible thought for prospective transplant recipients. For me, the site of stairs usually looked like Mt. Everest.
According to the Mayo Clinic, Left Ventricular Ejection Fraction (LVEF) is the true measurement of blood pumped by the left ventricle or main pumping station. The Right Ejection Fraction (RVEF) is the measurement of how much blood is pumped from the right side of the heart to the lungs in a single contraction. Ejection Fraction Measurements are interpreted as follows:
- 55-70% is considered normal.
- 40-55% is considered below normal.
- Under 40% usually confirm the presence of heart failure.
- 35% or less means the patient’s life is at risk.
A normal LVEV means the heart pumps more than 50% of the blood volume with each heartbeat. An LVEV of 65 indicates that 65% of the total amount of blood in the left ventricle is pumped with each beat. My left ventricle never recovered and in fact only continued to deteriorate after 7 heart attacks on September 10th 2000.
Realistically, patients with an Ejection Fraction above 19% are not usually admitted to transplant programs. After I had open-heart surgery in 2000, my Ejection Fraction was 22%. The physicians were hopeful that a portion of my heart would recover through medicine therapies. That did not work.
I had a defibrillator installed in 2003. When I was admitted to Columbia Presbyterian, my EF was 19%. My VO2 was 13%. The center looks for candidates with a VO2 of 14 or less. I was in congestive heart failure and suffering end stage heart disease.
Ejection Fraction is measured by a non-invasive procedure called an echocardiography or a cardiac catheterization or by a magnetic resonance imaging (MRI) scan of the heart. Sometimes a cat scan can also provide data while for other patients a nuclear stress test is effective.
Patients are often more concerned with the EF but low VO2 levels are life threatening and can transform relatively easy chores, like climbing the stairs, a monumental task. The VO2 can be increased due to excess body fluids. To offset this risk, physicians often prescribe Lasix to release the excess fluids through urination. The VO2 rate is determined through monitored stress tests.
Patients accepted for transplantation are usually in congestive heart failure and end stage heart disease although there are others considerations that may qualify the candidate. Before being admitted for transplantation, the candidate will be tested by the center wit consideration for the patient’s medical history.
When the patient is admitted for transplantation, they are given literature from UNOS describing the donor award program. Additionally, the center will provide the candidate a Guide Book. This is mandatory reading. In fact, it should be read by the patient numerous times and also read by the patient’s support network. The Transplant Guide at Columbia Presbyterian was extremely thorough.
Deciding Which Heart Transplant Candidates Are Transplanted
UNOS has a weighted system to determine the awards of donor organs to recipients. The system is designed to serve as a balance so that organs are available to patients regardless of financial status, race, sexual orientation or gender. Centers usually have age restrictions. Candidates should understand the center’s age restrictions.
UNOS operates under published guidelines. However, I found that the system is not as transparent as one would expect. The UNOS model is always subject to revisions. Assuming the age is compliant, the primary considerations are:
- Blood type
- Degree of illness
- Amount of time on the wait list
Yet there are other factors. I did not understand that until I received my first call. In that case, the organ was awarded to another patient. When the candidate responds to a call for transplantation, he or she will be prepped and the cavity size will be measures to make sure the donor’s heart is a good fit.
I also found that geographical consideration also entered into the equation. In retrospect, I came to believe that when I received my new heart, my proximity to the center played a role.
While certain criteria must be met, there are other conditions that can take the candidate off the list. The candidate must be in compliance and healthy enough to survive heart transplantation. These factors can cause the patient to be ineligible.
- Pulmonary hypertension
- Lung disease
- Advanced liver disease
- Renal insufficiency
To understand the need to stay as healthy as possible, at Columbia Pres and Tampa General, a person on the wait list would be placed in status 7 category, or temporarily unavailable for transplantation for as long as 6 – 8 weeks after contracting the flu.
I must admit that some other transplant candidates and successful recipients both expressed the grueling wait. For me, I tried to be as active as possible but was guarded about attending large functions held indoors. It is also important to keep a positive attitude in the face of adversity. I strongly suggest a good amount of stretching, prayer and any other holistic exercise. Keep yourself in shape, eat healthy and develop a lot of patience. Everyone wants you to succeed in this valiant fight. Do yourself and favor and be positive, strong and battle to stay healthy enough to receive the organ. Heart transplantation will not only prolong your life bit it will also change your perspective of life.