UNOS transplant rules: Hearts are given to the sickest patients within the local area first, then to the less urgent - but still local - patients. If there are no local matches, they will be offered to patients within a 500 mile radius, in order of medical urgency. Pediatric heart patients get first chance at hearts donated by adolescents. Patients under age 18 will be considered for hearts from donors aged 11 to 18 before adults of the same medical urgency. Data show that receiving a younger heart significantly improves the survival chances for children but does not make much of a difference to adults. Policy creates 3 categories for patients awaiting transplants. Status 1A - patients expected to die within 30 days get first chance at a donated heart Status 1B - patients who depend on certain drugs or mechanical devices but who are medically stable and expected to live more than a month. They get second chance at donated hearts Status 2 - patients include all other transplant candidates --------------------------------- Why New Transplanted Hearts Go Bad by Tina Adler At least half of all heart transplant patients develop coronary artery disease within 5 years of receiving their new heart. Almost half of these patients develop serious atherosclerosis which results in blockages of the arteries, and will die of heart attacks or heart failure within 2 years of developing the condition. Scientists thought the condition resulted from the body's immune system going into overdrive and trying to reject the new organ. However, new research shows that the drugs patients take to prevent rejection are also to blame. The drugs cause symptoms of diabetes, which lead to atherosclerosis, says Dr. Khanh Hoang of Stanford in the June 2, 1998 Circulation journal. Earlier, researchers found that transplant patients who failed a glucose-tolerance test had worse atherosclerosis than patients who passed the test, explains Dr. Hannah Valantine of Stanford. So in their new study, the researchers tested how diabetic and non-diabetic rats fared after having a heart transplant. They found that the non-diabetic animals didn't develop atherosclerosis. Also, the researchers gave some rats hearts from their identical twins, so the rats' immune systems would be less likely to reject the organ. Even these animals developed atherosclerosis, although it was not as bad as in the other animals. This suggests that transplant patients' immune responses are only partly to blame for the atherosclerosis. The drugs they take also cause their triglycerides to increase but this is not a key reason for their atherosclerosis. The researchers fed some rats extra fructose, which increases triglycerides, but these animals did not have worse atherosclerosis than the other rats. Transplant patients who become diabetic receive drugs for the condition but pre-diabetic patients may also benefit from treatment, says Dr. Valantine. These patients are usually insulin resistant, which means they can produce enough insulin, but their tissue isn't sensitive to it. They may require recently developed drugs that increase the body's sensitivity to insulin. Whether or not these drugs could prevent atherosclerosis from developing in the new heart should be studied.