The Total Artificial Heart: Clinical Application of the TAH
Clinical Application of the TAH
Each year, 17,000 to 35,000 persons die of prese-nescent heart failure, 5,000 to 11,000 become eligible for kidney transplantation, and 5,000 to 10,000 become eligible for liver or pancreas transplants. Not all of these individuals will receive new organs—donor organs are scarce, the cost of transplantation is high, and it is incompletely reimbursed.
TAH and Heart Transplantation
Since the first government TAH study in 1967, heart transplants have become a successful treatment for presenescent heart failure. Three-fourths of transplant patients survive two years; more than half live five years. Many survivors return to premorbid levels of function with a quality of life that is comparable to those receiving kidney transplants and better than that of those on dialysis.
The prospects for TAH recipients are not as optimistic. Even if strokes and infections can be prevented, external power mechanisms severely restrict patients” independence. Implantable power devices are years away. The implications of the success of heart transplantation for TAH development (either in decreasing the demand for a permanent TAH or in spurring interest in the TAH for pretransplant support of patients) are not addressed in the most recent government TAH study. where to buy asthma inhalers
There is a natural tension between research to develop a permanent TAH and easing acceptance criteria for heart transplant recipients. The desire for more “survivable” TAH subjects inclines TAH research towards patients who would be better medical candidates for transplants. Permanent TAH research subjects who subsequently become eligible for transplant are particularly troubling; at least one of the early TAH subjects would today have been eligible for a heart transplant simply because age limits have been liberalized. Subjects of permanent TAH implantation trials should be evaluated periodically to determine if their ineligibility for transplantation has changed and, if so, what the implications of this are for their continued participation in TAH research.