Listing and treatment of status 1 patient

Although therapies for heart disease continue to improve life expectancy, mortality remains high for those with end-stage heart disease despite aggressive medical treatment. The goal of transplantation is to improve survival in this difficult group of patients. Recent data show 1-, 3-, and 5-year posttransplant survival rates at 85.5%, 76.9%, and 69.6%, respectively. During the past decade, efforts have been made to expand the donor pool by increasing public awareness regarding organ donation and expanding criteria for donor acceptance. Transplant centers have become more restrictive in transplant candidate selection during this period, and the number of new registrations has decreased in the past 5 years. Despite these efforts, the supply-demand mismatch persists. As the number of those awaiting transplantation grows, so too have the number of transplants performed on an urgent basis. Three quarters of the organs allocated in 1988 to 1999 went to high-priority patients, whereas about half the transplants performed in 1995 were considered urgent. Despite this shift in patient acuity, outcomes have remained stable during the past decade. This stability is probably the result of the growing expertise in caring for these critically ill patients and to improved immunosuppression.