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Heart transplants save lives. Sometimes, however, a transplanted heart fails, the recipient goes back on the waiting list, and receives another heart transplant, or even a third. Is this fair to other people on the waiting list?

Waiting for a heart transplant can be a miserable experience. When your heart is so damaged that you need a new one, you aren't very likely to have the energy you need to work, to engage in hobbies, to get out and see people, or even to cook your own meals and keep your own house. You may be constantly concerned that you will catch some infection that will bounce you off the list, and you have to stay close to a transplant hospital, ready to come in on just two or three hours' notice when the center finally has a donor heart for you. 

The waiting time for heart transplants varies a great deal from location to location. In the UK, it may be as little as six months (on average). In the US, it can be as little as four months or as long as four years. A donor of the right blood type and body size has to be available to provide the heart. 

Usually, more than one potential transplant recipient fits the body size and tissue type restrictions, so allocation is made in accordance to pre-defined criteria. In the United States:

  • Status 7 patients are people who are temporarily "off the list" because of a change of their condition. Maybe they passed a stress test and their hearts are judged to be strong enough that they do not need a heart transplant. Maybe they have an infection that would put too much stress on a newly transplanted heart, and they need to wait until the infection clears. Maybe they had a fever that isn't explained and they can't go back on the waiting list until it is. Status 7 patients get their place on the list back when their condition worsens.
  • Status 2 patients are stable on oral medications, and able to live at home.
  • Status 1B patients need intravenous medications, whether at home or in the hospital, or they need a mechanical device to assist the heart.
  • Status 1A patients are in the most urgent need for a heart transplant. They are usually in the intensive care unit of the hospital. 
As hearts become available, they go to status 1A patients first, then 1B, then 2, and then 7. It's rare for anyone who isn't status 1A or 1B to get a heart. 
 
Patients don't go up the list when someone gets a transplant. The best matches are found in group 1A, and in the unusual event that there is no one in group 1A who is compatible to the donor, the doctors look at whether they can get the donated heart in time to someone in group 1B. 
 
An odd fact about heart transplants is that people whose hearts are "bad" but able to live at home, those in group 2, are actually more likely to die if they receive a heart transplant than if they don't. Among group 1 patients, about 27 percent die before a heart can be found. Some patients, however, get more than one heart transplant.
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