Dr. José González-Costello, Coordinator of the Heart Failure Unit at Bellvitge University Hospital's Cardiology Service, spearheads the revision of heart transplantation distribution criteria in Spain for 2023. Published in the Revista Española de Cardiología, the article has received approval from key entities, including the Spanish Heart Failure Association-Spanish Society of Cardiology (SEC-Heart Failure Association), the Spanish National Transplant Organisation (ONT), and the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE). Notably, other professionals from Bellvitge University Hospital (HUB) involved in the review include Dr Eva Oliver, from the Intensive Care Unit (ICU) and transplant coordinator, Dr José Carlos Sánchez Salado, specialist in the Cardiology Service, as well as Dr Nicolás Manito, former director of the Transplant Programme until his retirement.
The document constitutes a substantial contribution, revising the 2017 distribution criteria, with a primary goal of ensuring equitable access to heart transplantation (HT). The updated guidelines aim to prioritise patients in more compromised clinical situations, thereby enhancing post-heart transplantation survival. Additionally, the document seeks to facilitate access to HT for patients who are not recipients of a long-term ventricular assist device (LVAD)
The article stems from a consensus conference that brought together cardiologists, cardiac surgeons, paediatricians, and transplant coordination teams from across Spain. Additionally, doctors and nurses from the Spanish National Transplant Organisation (ONT) were actively involved. The objectives of the consensus conference were multifaceted: to analyse the organization and management of patients with advanced heart failure and cardiogenic shock in Spain; to critically review the distribution and emergency criteria for heart transplantation applied in other HT organisations; to compare the outcomes of listed and transplanted patients before and after the change of criteria in Spain in 2017; and to propose new distribution criteria for HT in Spain based on the analysis of available evidence and a multidisciplinary discussion.
Heart transplantation continues to be the optimal therapeutic choice for patients facing advanced heart failure (HF) unresponsive to conventional medical treatments. However, the availability of donors remains restricted, with approximately 300 per year in Spain. Consequently, the document represents a significant contribution with notable scientific impact. The article underscores an examination of distribution criteria for heart transplantation across different transplant organisations (Eurotransplant, France, the United Kingdom, and the United States). The updated criteria prioritize the most severely affected patients, defined as those with biventricular mechanical circulatory support (MCA), over those with univentricular support, aligning with the approach in the United States. To prevent futile transplantation, strict criteria for multi-organ failure are defined, which patients must not meet to be included or remain in the emergency code, similar to the risk score employed in France. The criterion of temporality of MCA is also eliminated, addressing potential penalties for patients without complications with the initial MCA and allowing to avoid additional surgeries with the aim of remaining in the emergency department.
Read the article here: https://www.revespcardiol.org/es-revision-criterios-distribucion-trasplante-cardiaco-avance-S0300893223003299