Some Patients See Short Cut to a New Heart

Sept. 25, 2005 — -- Every year, about one in three people on the nation's heart transplant list don't get a heart because too few are available.

Now, doctors are finding ways to use hearts that previously would have been rejected to help more people live longer.

Morris Shulman considers himself a lucky man. He had a heart transplant at 73 -- an age most doctors would consider too old to qualify for a new heart. But Morris received what's called an alternate heart, one that's slightly damaged or comes from an older or diseased donor.

Such a heart would be rejected for the regular transplant list, but Shulman says his alternate heart allowed him to watch his grandchildren grow up.

"I think that's the best part of the whole thing," he said. "I'd like to see my grandchildren get married, if I'm around that long -- which is another 15 years, maybe. But I figure I'm going to go to 100. I'm going to try anyway."

However, patients who receive lower-quality hearts have a lower success rate, especially in the first few months following surgery. For Shulman, it was touch and go.

"People gave me up for lost," he said, "including some of the doctors, because I had pneumonia and it was very serious. And I knew I would survive. And my wife knew I would survive. She knew because I was a strong guy."

Hope and Uncertainty

Few hospitals are willing to take the financial risk of an alternate heart program. Insurers examine a hospital's overall success rate to decide whether or not to cover heart transplants at that institution, so the majority of the alternate heart transplants are done at large teaching hospitals such as the one at the University of California-Los Angeles.

Dr. Hillel Laks, who pioneered UCLA's program, says most of the patients who get on the alternate list get a heart in about half the time it takes on the regular list.

The waiting is the hardest part for Dan Ramirez and his wife, Barbara. He received his first heart transplant at 42. But 16 years later, the heart is giving out. So now he's been placed on both the regular and the alternate transplant lists.

Ramirez isn't sure about the alternate heart.

"At first I didn't like it," he said. "I jokingly said, you know, 'I'm going to pay the same price for an alternate heart. I want a new heart. I want the biggest and the best model you have.'

"I'm paying the same price," he added. "But sure, I understand that things have changed. There's a lot more people. It takes longer to get a heart [the traditional way]."

Ramirez now is willing to accept whatever heart becomes available first. His wife said it was a simple decision.

"The bottom line is that he be here with us, and get another heart, and live longer," she said.

Dr. Donna Mancini, a cardiologist at Columbia Presbyterian Hospital in New York, said alternate heart programs have caused doctors to reconsider the donor criteria.

"We have really learned from this program … that we can be less stringent," she said. "So that ultimately benefits everyone, because it does increase a scarce resource. And I think that's the major benefit."

For Morris Shulman, his alternate heart means another wedding anniversary with his wife, Stella.

"I'm married 52 years; Oct. 12 will be 53 years," he said. "I think I married the most beautiful woman."