♪ ♪ ♪ ♪ >> WHEN AN APPLIANCE NO LONGER WORKS, IT'S POSSIBLE TO GET A NEW ONE.

BUT WHAT IF THE THING THAT IS NO LONGER WORKING IS YOUR HEART?

WHAT DO WE DO THEN?

STAY WITH US AS WE TALK WITH Dr. MATTHIAS LOEBE ABOUT THE MIRACLE OF CARDIAC TRANSPLANTATION NEXT ON "KENTUCKY HEALTH."

YOU MAY NOT REALIZE IT, BUT CARDIAC TRANSPLANTATION IS NOT A MODERN CONCEPT.

THE IDEA WAS INITIALLY CONCEIVED IN 1907.

IN 1964, THE HEART OF A CHIMPANZEE WAS TRANSPLANTED INTO THE CHEST OF A HUMAN.

AND THE FIRST HUMAN HEART WAS TRANSPLANTED INTO ANOTHER HUMAN IN 1967.

UNFORTUNATELY, THIS LIFE-SAVING PROCEDURE IS LIMITED BY THE AVAILABILITY OF SUITABLE ORGANS.

TO MITIGATE THIS NOVEL SOLUTIONS HAVE BEEN DEVELOPED INCLUDING THE DEVELOPMENT OF VENTRICULAR ASSISTIVE DEVICES AND CREATION OF ARTIFICIAL HEART.

AS THE SAYING GOES, EVERYTHING OLD IS NEW AGAIN.

IN 2022, THE HEART FROM A GENETICALLY-MODIFIED PIG WAS SUCCESSFULLY TRANSPLANTED INTO A PERHAPS ZENO TRANSPLANTATION MAY BE A SOLUTION TO A LACK OF ORGAN FOR CARDIAC TRANSPLANTATION.

TO HELP US GET A BETTER UNDERSTANDING OF WHAT CARDIAC TRANSPLANTATION IS, WHO NEEDS IT AND WHAT OBSTACLES MUST BE OVERCOME WE HAVE AS OUR GUEST Dr. MATTHIAS LOEBE, HE IS A GRADUATE OF THE MEDICAL SCHOOL FREE UNIVERSITY OF BERLIN FACULTY OF MEDICINE.

HE COMPLETED HIS RESIDENCY IN SURGERY AT THE GEORGE HOSPITAL JEWISH IN BERLIN AND DID A FELLOWSHIP IN CARDIOTHORACIC SURGERY AT THE GERMAN HEART INSTITUTE ALSO IN BERLIN.

HE HAS BEEN THE DIRECTOR OF THE CARDIOTHORACIC TRANSPLANT PROGRAM FOR BAYLOR AND HOUSTON METHODIST HOSPITAL AND MECHANICAL SUPPORT PROGRAM AT THE UNIVERSITY OF MIAMI.

HE JOINED THE FACULTY AT THE UNIVERSITY OF KENTUCKY AS PROFESSOR IN THE DEPARTMENT OF SURGERY, DIVISION OF CARDIO SURGERY, DIVISION OF CARDIOTHORACIC SURGERY AND DIRECTOR OF THORACIC TRANSPLANTATION AND MECHANICAL SUPPORT.

Dr. LOEBE, THANK YOU FOR BEING WITH US BECAUSE I COULD NOT HAVE GONE THROUGH ANYMORE OF OR ACCOLADES.

>> THANK YOU VERY MUCH.

>> HOW ARE YOU FEELING TODAY?

BEFORE WE GET DOWN TO THE MEAT OF TALKING ABOUT CARDIAC TRANSPLANTATION, IN MAY OF THIS YEAR, YOU PARTICIPATED IN A DOUBLE LUNG TRANSPLANT ON SOMEBODY.

FOR ME THAT IS REMARKABLE.

HOW DO YOU EVEN CONCEIVE OF THAT SORT OF THING.

>> LUNG TRANSPLANTATION IS RELATIVELY NEW AMONGST DIFFERENT ORGAN TRANSPLANTATIONS.

BUT HAS MADE ENORMOUS PROGRESS IN THE LAST 15 YEARS.

WE RESTARTED THE LUNG TRANSPLANT PROGRAM HERE AT THE UNIVERSITY OF KENTUCKY.

AND MOST OF THE TIME WE REPLACE BOTH LUNGS.

SOMETIMES ONLY ONE LUNG, LIKE LAST NIGHT WE DID ONE LUNG.

BUT THE OUTCOMES ARE REALLY GOOD.

WE HAVE MADE GREAT PROGRESS.

OUTCOMES ARE VERY GOOD AND PATIENTS CAN RETURN TO GOOD QUALITY OF LIFE.

>> YOU KNOW, I ALLUDED TO FLEXNOR WHO IN-WAS 1907 TALKING ABOUT THE FEASIBILITY OF HEART TRANSPLANT KIDNEY AND OTHER ORGANS BUT TELL ME ABOUT THE HISTORY OF CARDIAC TRANSPLANTATION.

>> CARDIAC TRANSPLANTATION, THE WAY IT IS TODAY WAS REALLY MOSTLY DEVELOPED AT STANFORD UNIVERSITY BY THE GROUP AROUND NORMAN SHOMWAY.

ONE OF THE VISITING PHYSICIANS FROM SOUTH AFRICA, CHRISTIAN BERNARD WAS SO IMPRESSED, HE WENT BACK TO CAPE TOWN AND DID THE FIRST HUMAN HEART TRANSPLANT AS YOU ALLUDED TO EARLIER.

AT THAT TIME, THE SURGICAL PROCEDURE WAS PROVEN TO WORK, BUT ALL THE OTHER THINGS DIAGNOSING REJECTION, TOLERANCE OF THE ORGAN, ALL THE IMMUNOLOGY AND MANAGEMENT PROBLEMS WERE POORLY UNDERSTOOD.

SO THERE WAS A WAVE OF MATTER WAVE OF HEART TRANSPLANTS AFTER THE FAMOUS BERNARD SURGERY AND AFTER ONE YEAR, MOST OF THOSE PATIENTS HAD NOT SURVIVED.

SO IT WAS DECIDED TO CREATE A MORATORIUM, AND ONLY STANFORD AND COLUMBIA AND NEW YORK CONTINUED TO WORK ON HEART TRANSPLANTS.

AND THEY REALLY MADE GREAT CONTRIBUTIONS IN THE MANAGEMENT OF THESE PATIENTS AND THE DIAGNOSIS OF REJECTION INFECTION.

AND THEN IN THE 1980s, WE GOT ACCESS TO NEW IMMUNOSUPPRESSIVE MEDICATIONS FIRST USED IN KIDNEY TRANSPLANTS SHOWN TO BE MUCH, MUCH BETTER IN THEIR EFFECT, MAKE REJECTION MUCH BETTER CONTROLLABLE.

AND SO TODAY, THAT'S REALLY OPENED A NEW ERA OF HEART TRANSPLANTATION THAT CONTINUES TO TODAY, AND WE LOOK AT SURVIVAL RATES OF 95% AFTER ONE YEAR AND LONG-TERM VERY GOOD LONG-TERM OUTCOMES OF GOOD QUALITY OF LIFE OF 20 YEARS OR SO AFTER A TRANSPLANT.

>> SO IT'S NOT SO MUCH THE TECHNICAL ASPECTS OF DOING THE PROCEDURE THAT WAS THE BIG OBSTACLE TO OVERCOME.

BUT IT WAS REALLY MANAGING THE REJECTION PART OF IT ALL.

>> ABSOLUTELY.

ABSOLUTELY.

THE WHOLE TEAM THAT IS INVOLVED IN MANAGING THESE PATIENTS DECIDING WHO TO TRANSPLANT, DECIDING WHICH ORGAN TO USE.

AND THEN MONITORING THESE PATIENTS AFTERWARDS, IMPROVEMENT IN THE MEDICAL THERAPY AND THE MEDICATIONS, ALL THAT, HAS LED TO THIS ENORMOUS IMPROVEMENT WE HAVE SEEN OVER THE YEARS.

>> WE KNOW THE SURGEONS OFTEN TIMES GET CREDIT LIKE THE QUARTERBACK ON THE FOOTBALL TEAM GETS MORE CREDIT THAN WHAT THEY MAY OR MAY NOT DESERVE.

I'M SURE IN YOUR CASE THAT IS NOT TRUE, BUT TELL ME ABOUT THIS TEAM APPROACH THAT YOU HAVE.

WHO IS INVOLVED?

WHAT ARE SOME OF THE PLAYERS?

>> YEAH, SO YOU ARE ABSOLUTELY RIGHT.

IN THE EARLY DAYS, IT WAS SURGEON WHO DID AN EXPERIMENTAL PROCEDURE.

NOW IT'S A TEAM THAT REALLY IS FOCUSED ON THE LONG-TERM SUCCESS OF THE THERAPY.

SO THE CARDIOLOGISTS ARE ENORMOUSLY IMPORTANT IN THE DECISION IN THE BEGINNING WHO REALLY NEEDS THE TRANSPLANT.

AND THEN IN MANAGING THE PATIENTS AFTER THE TRANSPLANT.

WE HAVE INTENSIVISTS 24/7 COVERAGE OF EXPERTS IN INTENSIVE MEDICINE WHO TAKE CARE OF THESE PATIENTS RIGHT AFTER THE SURGERY.

OBVIOUSLY ANESTHESIA IN THE O.R.

WE HAVE WHAT WE CALL COORDINATORS, SO, MOSTLY NURSES, WHO ARE THE FIRST RESPONDERS IN FOLLOWING THE PATIENTS, EVEN WHEN THEY GO HOME TO MAKE SURE THAT EVERYTHING IS OKAY.

YOU HAVE TO REMEMBER THAT OUR PROGRAMS ARE VERY STRICTLY SUPERVISED BY THE FEDERAL GOVERNMENT.

GOVERNMENT.

AND SO WE ARE MEASURED BY ONE-YEAR OUTCOMES.

MOST OF THE TIME IT'S THE QUESTION, RIGHT, THE POSTSURGICAL OUTCOME, BUT IN TRANSPLANT IT IS 12 MONTHS.

HOW MANY PATIENTS SURVIVE 12 MONTHS?

AND AS I SAID, WE HAVE TO ACHIEVE 94% ONE-YEAR SURVIVAL.

SO THAT MEANS EVERYTHING REALLY HAS TO WORK OUT WELL, WHICH IS TO THE GREAT ADVANTAGE OF OUR PATIENTS.

>> IN THE OPERATING ROOM, SOMEBODY HAS GOT TO PUMP BLOOD FOR THAT PATIENT.

SO WHO IS DOING THAT?

AND THEN AFTERWARDS, IS THERE SOME KIND OF REHAB PROGRAM THAT THE PATIENTS ARE ON?

>> YES, SO IN THE O.R.

YOU HAVE THE ANESTHESIOLOGIST, SCRUB NURSES, CIRCULATOR, THE PROFUSIONIST WHO RUNS THE HEART LUNG MACHINE THAT THE PATIENT IS CONNECTED TO WHILE WE EXCHANGE THE HEART.

WE ALSO HAVE OF COURSE A TEAM THAT GOES OUT AND GETS THE ORGANS SO THAT INCLUDES A COUPLE OF PEOPLE, AND THAT NEEDS TO BE COORDINATED BECAUSE WE HAVE ONLY A LIMITED PERIOD OF TIME THAT WE CAN KEEP THE HEART ON ICE IN THE ICE BOX OUTSIDE OF THE PROFUSION AND HUMAN BODY.

AS FAR AS AFTERCARE GOES, MOST OF THE PATIENTS GO TO A REHAB FACILITY TO GET STRONGER AND REGAIN THEIR QUALITY OF LIFE.

YOU PROBABLY HAVE TO THINK OF IT THAT THESE PATIENTS ARE SEVERELY SICK WHEN THEY GO INTO THE SURGERY.

THEY GO THROUGH AN EXTENSIVE SURGERY SO THEY HAVE TO RECOVER FROM THE TRAUMA OF THE SURGERY.

AND THEN THEY HAVE TO RECOVER FROM HOW SICK THEY WERE BEFORE.

>> WHAT IS THE SELECTION CRITERIA FOR A PATIENT TO HAVE OR EVEN BE PUT ON THE TRANSPLANT LIST?

>> SO THERE ARE A NUMBER OF TESTS THAT WE DO FIND OUT IF THE PATIENTS NEED A HEART TRANSPLANT.

BUT REALLY THE BEST PARAMETER IS HOW THE PATIENTS FEEL AND HOW OFTEN THEY HAVE TO GO TO THE HOSPITAL IN THE LAST 12 MONTHS FOR DECOMPENSATION, FOR SHORTNESS OF BREATH, AND HEART ISSUES.

SO IN STUDIES THAT WE AND OTHERS HAVE DONE, WE WERE ABLE TO SHOW THAT A PATIENT WHO HAS TO GO MORE THAN ONCE IN THE LAST 12 MONTHS TO THE HOSPITAL DESPITE GOOD MEDICAL THERAPY, WITH HEART FAILURE, THAT PATIENT BENEFITS GREATLY FROM TRANSPLANTATION.

SO I WOULD SAY THAT'S THE MAIN PARAMETER WE USE TO DECIDE WHETHER PATIENTS NEED TO BE TRANSPLANTED.

>> I KNOW THERE HAVE BEEN SOME CHANGES BECAUSE OF SOME CONTROVERSY A COUPLE YEARS AGO WITH PROCUREMENT AND DISTRIBUTING ORGANS.

HOW DOES IT GO AS FAR AS WHO GETS THE TRANSPLANT?

IS THERE AN ORGANIZATION THAT IS PUTTING THIS TOGETHER AND SAYING THIS IS WHERE THIS NEXT ORGAN IS GOING TO GO?

IT'S NOT NECESSARILY, WELL, THIS GUY HAS THE MOST MONEY AND THE MOST FAME.

THIS PERSON IS GOING TO GET IT OR IS IT BY NEED.

>> YOU ARE ABSOLUTELY RIGHT.

THE DATA OF THE PATIENT ARE PUT IN A COMPUTER THROUGH THE UNOS, UNITED NETWORK OF ORGAN SHARING.

AND THEN THEY ARE DISTRIBUTED NOW BASICALLY NATIONWIDE.

IN PARTICULAR WITH THE NEW SYSTEM, ALLOCATION SYSTEM, REALLY, THE SICKEST PATIENT GETS THE ORGAN OFFER FIRST WHICH, FOR US, MEANS THAT MOST PATIENTS THAT WE TRANSPLANT TODAY ARE IN THE INTENSIVE CARE UNIT ON SOME TYPE OF SUPPORT TO KEEP THEM ALIVE AND ARE REALLY VERY SICK.

WITH NEW TECHNIQUES WE ARE ABLE TO TRAVEL EVERYWHERE IN THE UNITED STATES TO GET THE ORGANS THE HEARTS, AND TO TRANSPORT THEM HERE IN LEXINGTON WITHOUT TAKING ANY PARTICULAR RISK BECAUSE WE PUT THE HEART IN A MACHINE WHERE IT'S PROFUSED AND IT KEEPS BEATING.

AND SO THAT IS GREAT PROCESS IN THE LAST COUPLE OF YEARS.

>> SO IT'S NOT JUST PUTTING THEM ON ICE ANYMORE.

YOU ARE ACTUALLY PROFUSING THEM?

>> YES.

THAT ALLOWS TO US GO TO CALIFORNIA, FLORIDA AND BRING THE ORGANS HERE.

>> NOW YOU HAVE YOU HAVE MENTIONED THAT ONE YEAR HAS TO BE ABOVE 94%.

WHAT IS EXPECTED NOW?

WHEN YOU TELL A PATIENT ONE YEAR IS GOOD ,BUT WHAT KIND OF SURVIVAL RATES ARE YOU LOOKING AT FIVE, 10 YEARS DOWN THE ROAD, POST TRANSPLANT?

>> SO WE KNOW THAT AFTER 14 YEARS, HALF OF THE PATIENTS ARE STILL ALIVE.

SO THAT MEANS THAT WE REALLY ARE ABLE TO OFFER 10, 20 YEARS OF GOOD QUALITY OF LIFE TO OUR PATIENTS, WHICH IS VERY SUBSTANTIAL.

>> TALKING ABOUT QUALITY OF LIFE.

WHAT CAN THIS PATIENT DO?

ARE THEY GOING TO GET OUT THERE AND RUN WITH THEIR GRANDCHILDREN OR THEIR CHILDREN OR ABLE TO GO ON LONG WALKS?

OR IS IT PRETTY MUCH A SEDENTARY LIFESTYLE?

>> THEY SHOULD HAVE A TOTALLY NORMAL EXERCISE CAPACITY AND QUALITY OF LIFE.

OF COURSE THEY HAVE TO TAKE SOME PRECAUTIONS FOR INFECTION BECAUSE WE GIVE THEM MEDICATION TO REDUCE THEIR IMMUNE RESPONSE.

AND SO THAT IS VERY SIMILAR TO WHAT EVERYBODY DID DURING COVID, WEAR A MASK IF YOU ARE AMONGST A LOT OF PEOPLE, WASH YOUR HANDS.

BUT OTHER THAN THAT, THESE PATIENTS HAVE A VERY NORMAL EXERCISE CAPACITY AND DEPENDING ON THEIR AGE, THEY GO BACK AND DO STRENUOUS SPORTS OR ROCK CLIMBING OR ALL KINDS OF ACTIVITIES.

>> UNLIKE LUNGS AND KIDNEYS, WHERE YOU HAVE TWO, WITH THE HEART, YOU ONLY HAVE ONE AND YOU ARE BASICALLY DEPENDING UPON SOMEONE BEING A DONOR AFTER THEY'RE DYING.

SO WHAT DO YOU DO FOR THAT INDIVIDUAL WHO HAS HEART FAILURE, BUT YOU ARE TRYING TO BRIDGE THEM SO YOU CAN GET A TRANSPLANT?

WHAT ARE SOME OF THE THINGS THAT YOU CAN OFFER THAT PERSON?

>> SO WE HAVE MEDICATIONS THAT WE CAN GIVE INTO THE VEIN AND, YOU KNOW, SUPPORT THE HEART WITH THOSE MEDICATIONS.

BASICALLY PUSH THE HEART TO BEAT MORE, BUT OBVIOUSLY THAT VERY QUICKLY RUNS OUT IN ITS CAPABILITY OF SUPPORT WE HAVE IN THE LAST 20 OR 30 YEARS, DEVELOPED MECHANICAL DEVICES TO SUPPORT THE HEART, WHICH KIND OF ARTIFICIAL HEARTS.

AND THERE WE HAVE SHORT-TERM DEVICES THAT WE CAN PUT IN THROUGH LIKE A CATHETER BASED PUMPS OR PUMPS THAT WE IMPLANT IN THE CHEST WHERE PATIENTS GO HOME AND CAN EXERCISE AT HOME AND REBUILD THEIR OVERALL QUALITY OF LIFE, EXERCISE CAPACITY AND THEN GO INTO THE TRANSPLANT IN MUCH BETTER SHAPE.

>> ARE THESE PUMPS CONNECTED TO SOMETHING EXTERNALLY OR IS IT ALL IMPLANTED IN THE PATIENT THEMSELVES?

>> NO, THE DEVICES WE HAVE TODAY ALL HAVE EXTERNAL BATTERIES AND CONTROLLERS THAT PATIENTS WALK AROUND WITH.

THEY'RE MINIATURIZED TODAY SO THEY DON'T SHOW ON THE OUTSIDE SO PATIENTS CAN REALLY HAVE A PRETTY NORMAL QUALITY OF LIFE.

THE ONLY THING THEY CAN'T DO IS GO SWIMMING BECAUSE THESE ELECTRICAL DEVICES CAN NOT BE UNDER WATER.

AND WE KNOW THAT WITH A NEW GENERATION OF PUMPS, THE FIRST-- THE ONE YEAR, TWO YEAR, THREE-YEAR OUTCOMES ARE EQUAL TO HEART TRANSPLANTATION SO WE REALLY CAN ALSO USE THEM AS AN ALTERNATIVE TO HEART TRANSPLANT IN THOSE PATIENTS.

>> SO THESE ARE THESE BALLOON PUMPS AND ALL THAT?

>> NO, L-VATS.

SO THERE IS A GOOD NUMBER OF PATIENTS WHO DON'T QUALIFY FOR HEART TRANSPLANT, AND WE CAN USE THESE PUMPS AS WHAT WE CALL DESTINATION THERAPY.

>> WHAT WOULD BE A PERSON WHO YOU WOULD CONSIDER THIS BECAUSE WHAT WOULD MAKE THEM NOT A CANDIDATE FOR HEART TRANSPLANT BUT YET A CANDIDATE FOR VENTRICULAR ASSISTIVE DEVICE.

>> PATIENTS WHO HAVE RECENT HISTORY OF MALIGNANCY, CANCER, THEY HAVE TO BE FIVE YEARS CANCER FREE, SO SOMEONE WHO DOESN'T FULL FULFILL THAT CRITERIA COULD BE SUPPORTED WITH ONE OF THOSE PUMPS.

WE HAVE PATIENTS THAT ARE MORBIDLY OBESE, AND FOR THAT REASON, DON'T QUALIFY FOR TRANSPLANT.

PEOPLE WHO STILL SMOKE AND DON'T WANT TO STOP SMOKING.

AND THEN OTHER REASONS THAT THEY ARE, YOU KNOW, DON'T QUALIFY FOR TRANSPLANT FOR REASONS OF THEIR LIFESTYLE.

>> SO WHAT IS THIS THING, THE INTRAAORTIC BALLOON PUMP.

IS THAT A BRIDGE?

>> WE SOMETIMES USE THAT AS A BRIDGE.

IT'S A BALLOON-- I MEAN, IT IS A BALLOON ON A CATHETER THAT INFLATES AND THEREFORE KIND OF SIMULATES THAT THE HEART IS EJECTING MORE VOLUME, THE 44 CCs IN THE BALLOON.

BUT THAT, YOU KNOW, THAT BASICALLY MAKES THE PATIENT BED RIDDEN IN THE HOSPITAL.

SO THAT IS CARRYING SOME RISK WHEN THEY'RE WAITING AND NOT ABLE TO EXERCISE OR GET OUT OF BED.

AND WE DON'T WANT THEM TO LOSE MUSCLE STRENGTH OR DEVELOP PNEUMONIA.

>> PATIENTS CAN GO ONE, TWO AND THREE YEARS WITH THESE ASSISTIVE VENTRICULAR DEVICES.

>> WE HAVE PATIENTS THAT HAVE LIVED 20 YEARS WITH THE DEVICES.

>> REALLY?

>> YES, AND I MEAN WE HAVE SEEN SEVERAL NEW GENERATIONS OF THESE DEVICES AND REALLY IN EVERY GENERATION, THE QUALITY HAS GOTTEN SO MUCH BETTER SO IT'S A VIABLE AND MEANINGFUL OPTION.

>> IS THIS THE ARTIFICIAL HEART?

>> IT HAS SUPPLANTED THE ARTIFICIAL HEART BECAUSE THE ARTIFICIAL HEART, WHICH THERE ARE-- WELL, ONE AVAILABLE RIGHT NOW-- HAS THE OBVIOUS DISADVANTAGE THAT YOU CUT OUT THE NATIVE HEART, AND YOU PUT IN A PUMP SO IF THERE IS ANY TECHNICAL PROBLEM, IF HAVE YOU TO CHANGE THE BATTERIES OR SO, THIS IS DANGEROUS.

>> A BIG DEAL.

>> IT'S A BIG DEAL.

THE ASSIST DEVICES YOU HAVE THE NATIVE HEART THERE AS A BACKUP SYSTEM AND SOMETIMES WE SEE RECOVERY OF THE NATIVE HEART, WHICH IS SOMETHING WE ARE-- PARTICULARLY IN LEXINGTON-- ARE VERY FOCUSED ON.

AND SOME PATIENTS YOU CAN TAKE IT OUT AFTER A YEAR OR TWO BECAUSE THEIR NATIVE HEART HAS RECOVERED FROM THE CARDIOMYOPATHY.

>> A COUPLE YEARS AGO, WE HEARD ABOUT THIS PIG MODIFIED SO THAT THE HEART FROM THE PIG COULD BE PUT INTO A HUMAN.

IS THAT SOMETHING THAT IS GOING TO BE DOWN THE HORIZON THAT WE CAN LOOK AT OR A ONE OF A KIND OF THING?

>> AT THIS POINT, THE EXPERIENCE BOTH WITH THE MODIFIED HEART AS WELL AS THE KIDNEYS, THAT WERE DONE MOSTLY IN THE HEART IN MARYLAND AND THE KIDNEYS IN NEW YORK, HAS SHOWN THAT IT IS NOT READY FOR PRIME TIME.

>> OKAY.

AND THAT THE CONCERNS THAT HAVE EXISTED FOR A LONG TIME, STILL HOLD TRUE.

AND SO I THINK IT IS FAR AWAY FROM BEING A VALUABLE OPTION.

NOW THINGS CHANGE AND BREAKTHROUGHS ARE MADE.

HOPEFULLY IN THIS AREA AS WELL.

BUT I MEAN IF YOU LOOK AT THE COST OF THIS THERAPY, IT IS TREMENDOUS TO RAISE THESE ANIMALS, MODIFY THEM.

THE RISK OF TRANSMITTING DISEASES FROM THE ANIMAL WORLD TO THE HUMAN IS A GREAT CONCERN AND IS ONE OF THE HEART RECIPIENTS, THE WORD IS THAT HE GOT AN INFECTION FROM THE ANIMAL.

AND SO THESE PATIENTS LIVED FOR A COUPLE OF WEEKS, BUT THAT, OF COURSE, IS NO COMPARISON TO THE THERAPIES WE HAVE AVAILABLE THAT GIVE 20 YEARS OF LIFE TO THE PATIENTS.

SO I THINK THERE IS GOING TO BE A LOT OF MORE WORK THAT NEEDS TO BE DONE.

OBVIOUSLY THERE ARE ENORMOUS ETHICAL QUESTIONS THAT I THINK NEED A PUBLIC DISCUSSION, CANNOT BE LEFT TO THE PHYSICIANS ALONE TO DISCUSS IF THIS IS ACCEPTABLE OR NOT.

SO I WOULD NOT EXPECT THAT IN OUR LIFETIME WE WILL SEE THIS.

>> IF COULD I ASK JUST A FEW TECHNICAL QUESTIONS BECAUSE I'M KIND OF CURIOUS.

I IMAGINE OTHERS MAY BE.

WHEN YOU ARE DOING A TRANSPLANT, ARE YOU REMOVING THE NATIVE HEART AND TAKING IT OUT AND PUTTING IN THE NEW HEART?

OR DO YOU KEEP SOME OF THE PATIENT'S ORIGINAL HEART IN PLACE AND DO SOMETHING ELSE?

>> YEAH, WE LEAVE THE BACKSIDE OF THE ATRIUM ON THE RIGHT SIDE AND ON THE LEFT SIDE SO THAT WE CONNECT THE HEART TO THE BIG VESSELS, YOU KNOW, AND TO THE VESSELS THAT RETURN THE BLOOD FROM THE LUNGS.

>> SO THAT CUTS DOWN ON SOME OF THE SEWING YOU MAY HAVE TO DO IN A MORE EFFICIENT MANNER.

>> YES.

THE SEWING PART IN THE HEART TRANSPLANT IS VERY SIMPLE.

YOU HAVE YOU SEW IN A CIRCLE.

>> I NEVER THOUGHT ABOUT IT LIKE THAT.

I GUESS YOU ARE RIGHT.

YOU ARE HOOKING THE EXISTING PLUMBING UP TO YOUR NEW PUMP THAT IS THERE.

>> YES.

>> SO WHAT ARE THE BIG CHANGES THAT YOU HAVE SEEN AS FAR AS SOME OF THE MEDICATIONS TO KEEP OR MAKE IT MOORE VIABLE FOR THESE PATIENTS ONCE THEY'VE HAD THE TRANSPLANT?

>> WE HAVE MUCH MORE TARGETED AND SPECIFIC IMMUNOSUPPRESSIVE MEDICATIONS THAT WE USE TODAY.

WE HAVE MUCH BETTER WAYS OF MONITORING THE PATIENT SO THAT WE CAN EARLY DETECT A REJECTION AND INCREASE THE MEDICATION A LITTLE BIT BEFORE THE PATIENT HAS ANY KIND OF SYMPTOMS.

WE HAVE BETTER WAYS TO PROTECT, IN PARTICULAR, THE KIDNEY FROM THE LONG-TERM EFFECTS OF THESE MEDICATIONS THAT ORIGINALLY WAS A PRETTY SERIOUS PROBLEM.

AS I MENTIONED, WE HAVE BETTER WAYS TO PRESERVE THE ORGANS.

AND WHEN WE PROCURE THEM FROM THE DONORS, AND SO THAT BY REDUCING THE TRAUMA DURING THAT PROCESS, WE HAVE BETTER FUNCTION OF THE TRANSPLANTED HEART AND BETTER LONG-TERM OUTCOME AS WELL.

WE HAVE IMPROVED THE MANAGEMENT IN THE ICU HAS BECOME SO MUCH BETTER THAT WE GET THE PATIENT OUT QUICKER, AND THEY CAN GO TO REHAB EARLIER AND BUILD UP THE MUSCLE MASS.

>> I IMAGINE YOU TALK ABOUT THE IMPROVEMENT IN THE ICU FOR THE PATIENT.

BUT I ALSO IMAGINE THAT WE ARE MAKING IMPROVEMENTS FOR THE DONOR TO MAINTAIN THE VIABILITY OF THE HEART.

SO WHAT PATIENTS ARE GOOD CANDIDATES TO BE DONORS?

WHEN YOU LOOK AT IT, ARE THERE ANY PARTICULAR-- OR SHOULD I SAY WHO IS NOT A GOOD CANDIDATE SO WHEN WE ARE TO APPROACH A FAMILY AND TALK ABOUT THIS VERY DIFFICULT DECISION TO MAKE.

WHO WOULD BE THE FAMILIES-- YOU WOULD SAY THIS PATIENT WOULD BE A GOOD CANDIDATE FOR BEING A DONOR?

>> WELL, OF COURSE, YOUNGER DONORS ARE BETTER CANDIDATES.

BUT OVER TIME,WE HAVEEXPANDED THOSE CRITERIA MORE AND MORE.

IN RECENT YEARS, WE HAVE STARTED USING HEARTS FROM PATIENTS WHERE THERAPY IS WITHDRAWN WHO ARE NOT BRAIN DEAD BUT WHERE THE THERAPY IS WITHDRAWN.

IT'S DONATION AFTER CARDIAC DEATH WHICH INITIALLY WAS COUNTERINTUITIVE THAT WE USE THE HEART.

BUT WITH THE MACHINES WE HAVE, WE WAIT THAT THE HEART IS IN ARREST IN THE DONOR, WE CAN THEN REMOVE IT AND PUT IT IN A MACHINE AND TEST IT AND MAKE SURE IT'S WORKING.

>> OF COURSE IF THERE ARE INFECTIONS OR-- >> PEOPLE WHO HAVE INFECTION, PEOPLE WHO HAVE, OF COURSE CARDIAC HEART DISEASE, CORONARY DISEASE, LONG HISTORY OF SMOKING, THAT WOULD NOT BE A GOOD DONOR.

I'M GOING TO GUESS YOUR ANSWER, BUT SHOULD WE ALL BE ORGAN DONORS?

SHOULD WE ALL SIGN THESE CARDS AND SAY YES?

>> YES, I THINK IT'S, OF COURSE REMARKABLE THAT SO MANY FAMILIES MAKE THAT DECISION IN A TIME OF GREAT DISTRESS AND GIVE A DONATION THAT IS HELPING SO MANY PEOPLE.

IF YOU THINK THAT EIGHT PATIENTS CAN BE SAVED BY THE DONATION FROM ONE ORGAN DONOR... >> WELL, Dr. LOEBE, I REALLY APPRECIATE YOUR DISCUSSING THIS WITH ME BECAUSE THIS IS ONE OF THE MORE FASCINATING THINGS IN MEDICINE, TRANSPLANTATION ALONE AND SPECIFICALLY CARDIAC TRANSPLANTATION.

I WANT TO THANK YOU FOR BEING WITH US TODAY.

I HOPE YOU HAVE A BETTER UNDERSTANDING OF WHO IS A CANDIDATE FOR CARDIAC TRANSPLANTATION, THE PITFALLS THAT MUST BE OVERCOME AND THE SELECTION CRITERIA AS WELL AS WHAT THE FUTURE HOLDS.

IF YOU WISH TO WATCH THIS SHOW AGAIN OR WATCH AN ARCHIVED VERSION OF PAST SHOWS, PLEASE GO TO WWW.ket.org/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH@ket.org.

PLEASE CHECK THE BOX TO BE AN ORGAN DONOR ON YOUR I.D.

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THANK YOU VERY MUCH.