The decline in heart transplantation in the UK

Heart transplants have offered a second chance of life for patients with advanced heart failure who fail to respond to optimal medical treatment and other treatments for more than 30 years in the United Kingdom. These people form a very small proportion (about 200) of the total number of people in the UK with heart failure (estimated at 750 000 currently). In patients with refractory heart failure who are relatively free of comorbidities, transplantation is seen as a final treatment option by clinicians who regularly treat heart failure. Survival at 10 years after transplantation is about 50%,1 and this is far better than for patients with advanced heart failure, whose survival is often less than 50% at one year.2 However, despite the announcement of a record high number of UK donors available for organ transplants (which includes all organs, not just hearts), heart donation continues to decline.3 Heart transplant rates (separated from rates for other organs) have consistently declined over the past 10 years, with a 46% reduction in that time period. Furthermore, this problem seems particular to the UK (figure⇓).