The Facts About Multiple Heart Transplants

Heart transplants almost always extend life. They just don't give recipients a normal lifespan. About 75 percent of heart transplant recipients live at least three years. About 50 percent live 10 years or more. Around four percent of all transplant recipients develop a condition called allograft vasculopathy, in which the body, despite anti-rejection drugs, rejects and destroys the new heart, so that a second transplant is required. Around 0.4 percent of patients develop this condition twice, requiring a third heart.

 

Every year, about one in 50 heart transplants is a second, third, or even fourth transplant due to rejection. Success rates for multiple transplant attempts are abyssmal. 

 

At the University of California at Los Angeles, for example:

Is it fair to give four percent of patients a second, third, or even fourth heart, when over a quarter of potential heart transplant patients will die waiting for their first? Many ethicists do not think so. 

 

Public perception of the fairness of the procedure is clouded by the fact that some famous people get multiple heart transplants, although in theory they are under the same rules as everyone else. 

 

Golfer Erik Compton, for example, has had two transplants. However, there are reasons he has found his way to the top of the list twice. For one thing, he is a professional athlete in good shape other than for his heart. His heart was destroyed by viral cardiomyopathy. He had his first heart transplant at the age of 12. He had his second heart transplant at the age of 28, healthy enough to drive himself to the hospital after he had a heart attack. To the extent of whether the question is "Will this transplant extend life?" the answer in Compton's case seems to have been an enthusiastic yes.

 

The recipient of the four-time heart transplant at UCLA, it should be noted, was a child. Giving this child a heart did not deprive any adult of the transplant, and children who need transplants are relatively rare. Nonetheless, some philosophers propose that there should simply be a ban on multiple transplants as long as some people are dying while on the waiting list, especially when it is children who are on the waiting list.

In 2015, an eight-year-old girl named Aiyana Lucas received her third heart at Seattle Children's Hospital. Because of her severe heart disease and her age, she went right to the head of the national heart transplant list. She got a new heart, but it failed to pump much at all, and she went right back on a heart-lung machine. She then went back to the head of the national heart transplant list, and got a second heart. That heart also failed, but because she had to go back on the heart-lung machine, again, she got a third.

 

Nobody expects Aiyana's family or doctors to turn down a fifth, sixth, or seventh heart if they become available. 

 

However, because other children may have died while waiting for their own hearts, the rules are likely to change to prohibit third and fourth heart transplants and to strictly limit second transplants, in the near future in the USA.