Policy 3.7 of OPTN describes the criteria for the allocation of thoracic organs (including hearts, heart-lung combinations, and single and double lungs). Heart allocation is determined by patient status and the geographic proximity of the donor hospital to the transplant center. Patients awaiting heart transplantation are classified according to medical urgency. If no suitable recipients are found within the local area, consideration is extended to others on the basis of their clinical status and a geographic sequence based on an established zone system.
In 2005, 313 heart transplants and 5 heart-lung transplants were performed for children under the age of 18 years (OPTN, 2006). A significant problem for children awaiting heart transplantation is allosensitization to HLA, which contributes to the mortality and morbidity of children on waiting lists and negatively affects the outcomes of the transplantation (Shaddy and Fuller, 2005). OPTN provides 5-year patient survival rates for children receiving heart transplants between 1995 and 2002. For adolescents aged 11 to 17 years, the 5-year survival rate is reported to be 69.4 percent. The rates are 75.5 percent for children aged 6 to 10 years, 72.6 for children aged 1 to 5 years, and 71.0 percent for children younger than 1 year of age (OPTN, 2006). Heart-lung transplants for children under the age of 10 years have much lower rates of success, with the 1-year patient survival rate reported to be less than 20 percent (Barr et al., 2005).
Approximately 1,000 lung transplants are performed each year, with only a few lung transplants being partial lobe transplants from living donors (Table 2-11). The first successful lung transplant was performed in 1963. In 2005, there were 1,408 lung transplants, with 1,407 deceased lung donors and 1 living lung donor (OPTN, 2006).
In 2003, emphysema, idiopathic pulmonary fibrosis, cystic fibrosis, alpha-1-antitrypsin deficiency, and primary pulmonary hypertension were the most common diagnoses contributing to the need for transplantation (Barr et al., 2005). Most lung transplant recipients are older, primarily 50