Heart failure is common but not inevitable in old age
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To mark Organ Donor Awareness Week we look at heart transplantation in Ireland
Writing in the 2018 annual report of Organ Donation and Transplant Ireland (ODTI), which was launched recently to mark Organ Donation Awareness Week (March 30 to 06 April), Professor Jim Egan, the Director of ODTI said the Human Tissue Bill and its expected inclusion of a “soft opt out” approach to organ donation represents “a significant milestone” in Irish healthcare.
According to Prof Egan, the new legislation combined with encouraging donations from older people and the introduction of deceased cardiac donation would increase organ donation rates and save many lives.
In 2018 a total of 18 heart transplants took place in Ireland and speaking to the Irish Heart Foundation, Mr Lars Nölke, Consultant Cardiothoracic Surgeon and Head of the National Heart and Lung Transplant Centre at the Mater Hospital in Dublin, said that Ireland is in the upper half of European countries in terms of the number of transplants per million of the population.
Overall 384 heart transplants have been performed at the Mater Hospital since 1985 at an average of approximately 11 a year. The longest living recipient of a heart transplant in Ireland is 32 years post-transplant and still going strong.
Mr Nölke said that there were currently 12 people on the waiting list for a donor heart with some waiting for up to two years.
There are currently 12 people on the waiting list for a donor heart with some waiting for up to two years.
Mr Nölke explained that Ireland could increase its pool of heart donors by using organs from “increased risk donors.” These include older people and people with a history of drug use, cancer or an infectious disease which can be treated with effective therapy such as Hepatitis C.
When it comes to donor hearts a person aged 50 would be considered an older donor but worldwide that age (of heart donors) was steadily increasing, he said.
While patients in the Mater are currently offered a donor heart from increased risk donors, this usually takes place immediately prior to the operation and if the patient refuses then the next person on the list is offered the increased risk donor heart. Refusing a donation from an increased risk donor does not affect a person’s place on the list.
“Everyone goes on to a common list and the sickest person on the night gets transplanted first so, that might be the person who went on it yesterday or it might be the person who has been on it for a year. The downside of it is, if you are not the sickest patient on the list, you may go through a long period of time where you just don’t get called because there is always somebody sicker than you. It’s a difficulty with not enough hearts available for all the patients,” Mr Nölke explained.
“That is why the push is to maybe use donors with extended criteria…we are about to start off a process where we are going to start consenting recipients to use hearts from increased risk donors.”
“For some people getting their heads around that is very difficult but the contrast always needs to be that without transplant, all of these patients have a very limited life expectancy. The reason they are on the list is that they have failed maximum medical management…and without a transplant they are not going to survive,” he added.
“ Talk about donation, while you never want to be a donor it is a fantastic gift,"
Another way to increase the number of donor hearts would be to use hearts after what is termed Deceased Cardiac Donation or DCD. This is where the donor suffers a catastrophic brain injury that is not severe enough to declare them as brain dead but is such a big brain injury that there is no chance of them surviving with any quality of live. In these instances, with the agreement of the family, the donor is taken off mechanical ventilation and if death occurs it is described as cardiac death as the heart will stop beating. After an agreed period of time (minutes) the heart is then attached to a machine called an Organ Care System for the Heart, which contains an artificial lung and a pump, and it starts beating again. With an Organ Care System, the heart can be preserved for up to six hours.
Mr Nölke said heart transplants following DCD was not carried out in Ireland as we do not have an organ care system for hearts here which would cost approximately €45,000 per transplant. He added that discussions were ongoing re the possibility of doing DCD heart transplants in Ireland over the coming years and approximately 100 such transplants had already taken place worldwide. DCD kidney and lung transplants have been performed in Ireland and have been an important addition to the pool of donors.
“Organ care system is a potential strategy that is being used worldwide. Every extra donor you get is an extra donor even if it is one or two every second year it is well worth it, he added.
" We would ask everyone to consider organ donation and discuss their wishes with their family,”
Finally, Mr Nölke said he would urge everyone to discuss their organ donation wishes with their families.
“Talk about donation, while you never want to be a donor it is a fantastic gift. If in those terrible circumstances your family can give that gift it will save lives.”
Commenting Dr Angie Brown, Medical Director of the Irish Heart Foundation said, “as science and technology improves, we have the opportunity to increase the potential pool of organ donors so we would ask everyone to consider organ donation and discuss their wishes with their family.”
Organised by the Irish Kidney Association, the focus of Organ Donor Awareness Week is to remind people to talk to their families about their organ donation wishes and keep the reminders of their decision visible by carrying the organ donor card, permitting Code 115 to be included on their driver’s licence or downloading the ‘digital organ donor card’ APP to their smartphone.
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