Introduction

On December 3, 1967, Mr. Louis Waskansky underwent the first successful human cardiac transplant, performed by Dr. Christian Barnard in Cape Town, South Africa. This milestone was reached after the technical aspects of orthotopic cardiac transplantation had been described in 1959 by Ross M. Brock of Guy's Hospital in London. The following year Shumway published the seminal paper on orthotopic cardiac transplantation in which the technical aspects, recipient support and donor organ preservation were integrated into a single approach. The initial experience with heart transplantation in the ensuing twelve months after Barnard's first operation was dismal: 71 of the first 100 recipients died. The introduction of cyclosporine provided the next breakthrough that allowed hospital mortality to drop below 10 percent and five-year survival rate to approach 80 percent.

There are currently 143 heart transplant centers in the United States and the number of transplantations has plateaued at an annual rate of approximately 2300 per year in the United States and 3400 per year worldwide. These plateaus are due to limitations of donor availability and as a result approximately 30 percent of patients on the waiting list will die before a suitable organ is available.

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