Cardiac Transplantation: A Quarter Century of Progress

This article provides a review of the current status of cardiac transplantation, which offers the only viable alternative for the management of patients with refractory congestive heart failure. The criteria for recipient evaluation and selection are discussed. The major limitation to the number of potential recipients of cardiac transplantation is the availability of donors, numbering about 2000 per year. The current one-year survival rate is approximately 80%, while the 5-year survival rate is in excess of 70%. These numbers confirm the therapeutic benefit derived from cardiac transplantation, and are in marked contrast to the one-year mortality rate of 30–60% experienced by patients with New York Heart Association class IV congestive heart failure. The long-term complications of cardiac transplantation include acute and chronic rejection, infection, the side effects of immunosuppressive agents (including nephrotoxicity and hypertension), the development of neoplasms, and accelerated transplant coronary arteriopathy. This paper also emphasizes the areas in which investigation into the behavioral aspects of cardiac transplantation may be directed, including: (a) study of the individual and group attitudes toward organ donation; (b) psychologic implications of mechanical circulatory support as an alternative to cardiac transplantation; (c) in the transplanted patient with a denervated heart there is the opportunity to study the interaction between the autonomic nervous system and behavioral stimuli; (d) the psychologic adaptation of the recipient to organ transplantation; (e) the role of educational programs designed to influence favorably the attitude of the general population toward organ transplantation; and (f) in the future, the psychologic aspects of xenograft transplantation as an alternative to homograft transplantation.