Heart transplant recipients living longer

Canada and the U.S. have their differences, but when it comes to saving desperately ill children, there are no boundaries

By Andre Picard

Public Health Reporter

September 23, 2004

Data released yesterday by the Canadian Institute for Health Information show that, of the 46 pediatric heart transplants performed in Canada during the past two years, 18 donor hearts came from the U.S. Canada, in turn, sent three pediatric hearts to the U.S. for transplant.

"This kind of sharing occurs in pediatrics because the size of the heart is such an important factor," said Dr. Lori West, medical director of the heart transplant program at the Hospital for Sick Children in Toronto. "Everybody goes out of their way to find the right match because it would be such a tragic waste to not use a donor heart."

Overall, however, there remains a desperate shortage of hearts for children and adults alike.

There were 321 heart transplants performed in Canada over the past two years, of which 33 hearts came from the U.S. But at the end of 2003, there remained 131 people on the waiting list, including 37 children. Each year, about 40 patients in need of a heart die waiting. "There just aren't enough hearts to go around, especially for babies," Dr. West said.

Part of the reason is a steady decline in trauma cases due to the use of seat belts, child car seats, bicycle helmets, gun laws, and other public safety measures. (One of the principal reasons the U.S. has more organs available is gun-related injuries.)

But a bigger problem, Dr. West said, is a failure to recruit donors: People don't sign their organ donor cards, physicians and nurses don't make organ donation a priority, hospitals don't allocate resources to caring for the brain dead until organs can be harvested. Even when a person donates organs, the heart can be used only about one-third of the time because it is so fragile.

Dr. West, who is also a spokeswoman for the Heart and Stroke Foundation, urged everyone to sign an organ donor card and consider donation when tragedy strikes.

"Heart transplant is a really good therapy. It can offer very ill children years of happy and productive life. For little children, we hope to get 20 to 30 years after transplant," she said. After that time, they would be in need of another heart.

In fact, the ray of hope in the new data is the ever-increasing survival rate among heart transplant recipients. More than 78 per cent of heart transplant recipients now survive at least five years after transplant.

Pediatric heart transplants began only in the mid-80s, but infants have far better outcomes than adults.

The principal reasons children require heart transplants are congenital malformations of the heart and a failure of the heart muscle, often caused by an infection.

The organ donor rate in Canada has hovered around 13 to 15 per million population for the past decade, compared to 18 to 22 per million in the U.S.

Organ donors are an aging population: Two in every five donors are now over the age of 50.

"The shortage of donors, combined with increasing age has had two major impacts," said Dr. Vivek Rao, a heart transplant surgeon at Toronto General Hospital and an adviser to CIHI.

"First, there are an insufficient number of small hearts available for children who require heart transplantation. And second, there are fewer medically suitable hearts for adults awaiting heart transplantation. To ensure that children and our sickest patients receive needed treatment, we have relied increasingly on donor hearts offered from U.S. organ procurement organizations."

Copyright © 2004 Bell Globemedia Publishing Inc.

This article posted October 30, 2004.