Vanderbilt Transplant Center sets world record for heart transplants in 2024
The history of heart transplants has always engaged our curiosity as it represents a step towards avoiding death, at least temporarily. Several outlets reported that in 2024, Vanderbilt University Medical Center (VUMC) set the world record for the number of heart transplants performed in a year, with 174 procedures. This is no small feat. Heart transplants require a tremendous amount coordination, human resources, very motivated surgeons, and often luck, to say it bluntly -- it’s risky business.
The History of Heart Transplantation
Heart transplants are a testament to human endurance and dedication, it’s filled with groundbreaking achievements and dramatic stories, much like that of early surgeons such as Willam Halstead MD, who once removed his mother’s gallbladder on a kitchen table, showcasing the unwavering commitment of medical professionals in the face of adversity.
Here’s an Overview of Heart Transplants:
Early Attempts and Pioneers:
1905: The first recorded attempt at a heart transplant was by Alexis Carrel, who won a Nobel Prize for his work in vascular suturing. He experimented with dogs, but none were successful.
1950s-1960s: Dr. Norman Shumway at Stanford University conducted extensive research on dogs, developing many techniques still used today. His work laid the groundwork for human heart transplantation.
The First Human Heart Transplant:
1967: Dr. Christiaan Barnard performed the world’s first human heart transplant in Cape Town, South Africa, on Louis Washkansky. The donor was Denise Darvall, who’d been declared brain dead after a car accident. Washkansky survived for 18 days, which was a significant achievement at the time. He ultimately succumbed to pneumonia due to the immunosuppressive drugs used to prevent rejection. This event was a medical milestone but also sparked a global ethical conversation.
Late 1960s to Early 1970s: Following Barnard’s initial success, many centers around the world attempted heart transplants, but with high early mortality rates (around 75% within a year), the procedure fell into disfavor. The primary issues were organ rejection, infection, and lack of effective immunosuppression.
The Cyclosporine Revolution:
Late 1970s to Early 1980s: The introduction of cyclosporine, an immunosuppressive drug, marked a pivotal moment in the history of heart transplantation. It significantly improved survival rates by reducing rejection, a major hurdle in the early days. This breakthrough saved more lives and paved the way for further advancements in the field.
1981: Dr. Norman Shumway finished what he started, performing one of the first successful heart transplants with cyclosporine at Stanford, leading to a resurgence in heart transplantation.
1983: Bill Eastwood - Longest Surviving Transplant Patient at His Time. Eastwood received his heart transplant from Dr. Magdi Yacoub at Harefield Hospital in England. Eastwood, who had severe heart disease, was in dire need of a transplant. He lived for 30 years after the transplant, passing away in 2013, making him one of the longest-surviving heart transplant recipients at that time.
1984: Baby Fae - The First Infant to Receive a Xenotransplant Heart. Stephanie Fae Beauclair, known as “Baby Fae,” was born with hypoplastic left heart syndrome, a condition where the left side of the heart develops improperly. Due to the lack of human infant donors, Dr. Leonard Bailey at Loma Linda University Medical Center in California transplanted a baboon heart into Baby Fae when she was 12 days old. This was an attempt at xenotransplantation (transplant from one species to another). Baby Fae lived for 20 days post-surgery, eventually succumbing to heart failure and rejection of the baboon heart. People were glued to their television sets every night to get updates. The case was highly controversial, raising ethical questions about xenotransplantation, the use of animal organs, and the moral implications of such experimental surgeries on infants.
Current Challenges in Heart Transplants
Heart transplant outcomes in the US have improved but are still far from ideal. One-year survival percentages after heart transplantation are estimated to be 85% to 90%; ten-year survival is about 55%. In the US, this number has been relatively stable for the last decade despite a number of substantial advances in the field.
Organ Shortages: Despite technological advances, the demand far outstrips supply, leading to long waiting lists and mortality. Could stem cells and 3D printing be a solution?
Ongoing ethical debates continue about organ allocation, using marginal donors, and the socio-economic aspects of who gets access to transplants.
Immunological Barriers: Overcoming acute and chronic rejection through better immunosuppression.
How Many Heart Transplants?
However, as we celebrate this medical milestone, it’s crucial to delve deeper into the questions that arise from such accomplishments. Why does the United States, and Vanderbilt in particular, require so many heart transplants?
Looking at the number of heart transplants in different countries over the years is fascinating. Here’s a small comparison of heart transplant activities based on the available data:
Estimated Number of Heart Transplants performed:
United States:
2000: 2,000
2015: 2,800
2020: 3,650
2022: 4,169
2023: 4,545
2024: 4,572
Europe:
2022: 2,444
In Denmark, approximately 20 to 30 are performed annually.
In France: about 400 annually.
Japan: about 50 annually.
China: This one blew me away, since it’s a country of 1.4 billion. Based on the available data:
From 2015 to 2020, the annual number of heart transplant surgeries performed and reported by transplant centers in China was as follows: 279, 368, 446, 490, 679, and 557 cases, respectively.
Why So Many Heart Transplants?
1. End-Stage Heart Failure
Congestive Heart Failure (CHF) is the primary reason for needing a heart transplant. CHF results from weakened heart muscles that pump blood suboptimal, leading to shortness of breath, fatigue, and fluid retention. Causes include:
Coronary Artery Disease (CAD): The most common cause is narrowed arteries, which reduce blood flow to the heart muscle. I wrote about CAD here.
Cardiomyopathy: Diseases of the heart muscle that can be inherited, caused by infections, or result from prolonged high blood pressure, among other causes.
Valvular Heart Disease: Severe dysfunction of heart valves leading to heart failure.
Myocarditis: Severe inflammation of the heart muscles is often due to viral infections. Just remember that there’s no “mild” cases of myocarditis!
2. Congenital Heart Defects
Some individuals with complex congenital heart diseases might eventually require a heart transplant if earlier interventions like surgery or medications fail.
3. Rejection of Previous Transplants
In rare cases, heart transplant recipients might need a re-transplant due to chronic rejection or failure of the first transplant.
4. People are Living Longer
We can reverse sudden (acute) cardiac ischemia with stents and open-heart surgeries, which contribute to an aging population. As a result, people live longer, and there’s an increase in conditions that lead to heart failure. Older individuals are more likely to have chronic conditions that can culminate in the need for a heart transplant.
Vanderbilt’s Heart Transplant Milestone: Are they pushing heart transplants too far?
Before we dive into the debate on when enough becomes too much, the other moments Vanderbilt University Medical Center (VUMC) have pushed Mother Nature too far:
Transgender VUMC Health Clinic Controversy:
In 2022, Conservative Daily Wire commentator Matt Walsh published reports claiming that Vanderbilt was performing gender-affirming surgeries on minors for financial gain. Videos emerged of doctors discussing the profitability of these surgeries. VUMC denied the allegations, emphasizing that they require parental consent and adhere to state laws and professional standards. Following public and political backlash, VUMC announced a suspension of this program. This controversy later morphed into the US vs. Skirmetti Supreme Court oral arguments. See here.
RaDonda Vaught Case:
Nurse Vaught was involved in a tragic medication error leading to the death of patient Charlene Murphey. Vaught gave Vecuronium, a paralytic, instead of Versed, a sedative, due to a mix-up in the automated dispensing system where she used the override function. One may recall that this exact same thing happened in Samoa when a nurse mixed the MMR vaccine with Vecuronium instead of saline, which killed at least two infants.
Wrong-Site Surgery:
Carla Miller sued Vanderbilt after doctors mistakenly operated on her right kidney instead of the left during a procedure in November 2017. This mistake led to severe health consequences for Miller, who required lifelong dialysis. She later died, and the case continued posthumously.
Misplaced Central Venous Catheter:
A resident mistakenly placed a central venous catheter into a patient’s carotid artery instead of the jugular vein, leading to the patient’s death from a stroke the following day. I once witnessed a nurse anesthetist “coach” another nurse anesthetist into inserting a catheter into the carotid artery – a stark reminder of the countless incidents the public rarely glimpses when stepping into a hospital.
The Heart of the Matter: Why So Many Transplants?
As with many things in life, follow the money. The sheer number of heart transplants performed at VUMC raises critical questions about the state of cardiovascular health in the United States. There’s a lot of profit in transplants. While the donor gives their organs at no cost to them (just like with giving blood), the average cost for a heart transplant exceeds $ 1 million:
Pre-transplant care: Around $50 thousand for evaluations, tests, and other preparations.
Organ procurement: Costs for locating and transporting the donor’s heart are over $100 thousand.
Surgical procedure and hospital stay: Often exceeds $1 million.
Physician and surgeon fees: These are in addition to the hospital charges. Heart transplant surgeons earn in upwards of a million dollars per year, depending on their productivity.
Post-transplant care: For the first six months, costs can exceed $250,000.
Lifelong immunosuppression and other necessary drugs cost around $50 thousand.
The Cardiovascular Heart Disease Epidemic
Why are we celebrating this “world record” when the real issue is the epidemic of heart disease? The focus should be on — why so many individuals reach the point of needing a transplant. This points to systemic neglect in preventive healthcare, where chronic diseases are left to escalate until drastic intervention is the only option.
The high volume of heart transplants points to a broader public health issue: the prevalence of heart disease in the US. While VUMC’s success in transplantation is commendable, it also serves as a stark reminder of the need for:
Preventive Healthcare: The focus must shift towards prevention—diet, exercise, smoking cessation, and managing conditions like hypertension and diabetes that lead to heart failure. Most people stopped smoking, yet we’re still experiencing high rates of cardiovascular disease. This also questions the wisdom of low-fat diets, seed oils, and cholesterol-lowering drugs.
How can we enhance our preventive strategies to reduce the need for such invasive procedures? People need to start caring for their cardiac health much earlier. See my CAC article here.
Public Health Education: There’s a clear call for more robust public health campaigns to educate on heart health, potentially reducing the future need for transplants.
The US has one of the highest rates of heart disease in the developed world. Approximately one million people die each year from cardiovascular disease. Genetics, stress, sedentary lifestyles, obesity, and high rates of smoking contribute significantly to this. I would say diet comes after all these things.
In conclusion, it’s amazing to see Vanderbilt University Medical Center perform so many heart transplants, but this achievement mustn’t distract us from the critical issues. The question isn’t just about how many transplants can be performed, but why the need is so high in the first place. Is this a reflection of a nation’s health crisis compounded by chronic disease and inadequate education? Whatever we are doing, isn’t working.