Heart transplants 'only benefit sickest'

Transplants may not benefit lower risk patients

Heart transplants benefit only the sickest patients, researchers have said.

The findings suggest that some donor organs - which are in increasingly short supply - may be given to patients who do not benefit.

Many doctors believe that all patients who reach an advanced stage of heart failure are likely to live longer if they undergo transplant surgery.

More than 80% of hearts in Germany are not allocated to those who can be expected to have a survival benefit from cardiac transplantation

Dr Mario Deng, Columbia University, New York

But that view has been challenged by work carried out by researchers led by Dr Mario Deng of Muenster University, Germany, and Columbia University, New York.

Dr Deng's team found transplant surgery only improves survival time in patients with the worst heart failure, and the highest risk of death while on the waiting list.

The researchers identified all 889 adult patients listed for a first heart transplant in Germany in 1997.

They divided the patients into three groups, those at low, medium and high risk of dying on the waiting list.

Longer life expectancy

They compared the mortality rates between those who had received a transplant and those who were still on the waiting list.

The researchers found that only patients in the high-risk group lived longer than predicted following transplant surgery.

Writing in the British Medical Journal, they suggest that transplantation should be limited to the sickest patients.

Treatment for less sick patients should be focused on attempts to improve the function of their own hearts, they add.

Dr Deng told BBC News Online: "More than 80% of hearts in Germany are not allocated to those who can be expected to have a survival benefit from cardiac transplantation."

'Better use of donor organs'

However, the researchers concede that they did not examine whether transplants led to a better quality of life, or whether they were more cost-effective than non-surgical treatment.

In an accompanying editorial, Professor Sharon Hunt, of Stanford University in California, reiterates these views.

She said the research might help to ensure that donor organs were given to patients most likely to benefit.

It might also intensify moves to develop alternatives to transplantation.

Transplant referral

Professor Sir Charles George, medical director of the British Heart Foundation, said about 300 transplants were carried out in the UK each year.

Of these, the majority are carried out on people with severe heart failure.

Sir George said: "If you are referred to a transplant centre you will be put through a series of tests to establish what your outlook would be if you do not have transplantation.

"Patients are usually added to a transplant waiting list when it is thought they have a 50/50 risk of dying within a year even if they are given treatment with drugs such as diuretics and ACE inhibitors."