Heart transplantation

We review the contemporary management of end-stage heart disease with cardiac transplantation and the use of ventricular assist devices. When indicated, cardiac transplantation remains the gold standard therapy for end-stage heart disease. The outcome of transplantation is dependent upon the entirety of the transplantation process which consists of recipient factors, donor factors, organ retrieval, organ preservation, implantation and long-term management of transplant-related complications such as infection, rejection, malignancy and immunosuppression. However, despite best efforts a number of patients will die every year on the transplant waiting list. This is primarily due to a shortage of donors. In the recent years we have developed strategies to increase the number of organs, quality of donors and developed ways to support decompensated patients until a suitable organ has become available. The latter is known as bridging to transplantation. The most recent and promising development in this field has been in heart procurement. The traditional mode of preservation and transport of hearts on ice has been replaced by a sophisticated, device assisted organ care system (OCS). This probably reduces the ischaemic burden, permits longer cross-clamp times and may significantly increase the number of donor organs.