Patel Jignesh, Kobashigawa Jon A
David Geffen School of Medicine at UCLA, Division of Cardiology, Los Angeles, California, USA.
Curr Opin Cardiol. 2004 Mar;19(2):162-5. doi: 10.1097/00001573-200403000-00017.
Advances in immunosuppression and surgical techniques have allowed cardiac transplantation to become a viable option and the treatment of choice for select patients with end-stage heart failure. The success of the procedure has, however, led to a discrepancy between the number of donors available and the number of patients awaiting cardiac transplantation. As wait times for heart transplant recipients increase, nonstandard donor hearts are increasingly being used for higher risk recipients and critically ill (Status I) patients. We review the development of two recipient lists as a way to provide cardiac transplantation as an option to recipients who would be otherwise ineligible, and determine its impact on expanding the donor pool. Other methods of expanding the donor pool are also reviewed.
The alternate list appears to be successful in offering transplantation to patients (mostly older patients) who would not normally be eligible for this life-saving procedure. The alternate list (by changing donor organ acceptance criteria) and ongoing programs to increase organ donation have helped to expand the donor pool.
The donor organ shortage will continue as an increasingly older population develops end-stage organ disease. Expanding the donor pool by a variety of methods will be essential to extend the lives of these patients.
免疫抑制和外科技术的进步使心脏移植成为一种可行的选择，也是某些终末期心力衰竭患者的首选治疗方法。然而，该手术的成功导致了可用供体数量与等待心脏移植的患者数量之间的差距。随着心脏移植受者等待时间的增加，非标准供体心脏越来越多地用于风险较高的受者和危重症（I级）患者。我们回顾了两个受者名单的发展情况，以此作为向那些原本不符合条件的受者提供心脏移植选择的一种方式，并确定其对扩大供体库的影响。还回顾了其他扩大供体库的方法。
候补名单似乎成功地为那些通常不符合这种救命手术条件的患者（大多为老年患者）提供了移植机会。候补名单（通过改变供体器官接受标准）和正在进行的增加器官捐赠的项目有助于扩大供体库。
随着人口老龄化导致终末期器官疾病患者增多，供体器官短缺问题将持续存在。通过多种方法扩大供体库对于延长这些患者的生命至关重要。
