Pizzas galore!

Four days later Maidment’s heart was sufficiently rested from its trauma for the pump to be removed. Two weeks after that, he was off the drugs that had kept him unconscious while he recovered. Coincidentally, a letter announcing his promotion from corporal to sergeant had arrived at his home during his suspension from existence. Life, for him, goes on.

For many sufferers of heart problems, that is not the case. Britain has one of the highest heart- disease rates in the developed world: 700 people a day have a heart attack, which usually leaves the muscle damaged and weakened. Every year 100,000 people die of heart failure, either as a result of this damage or as a consequence of infection, high blood pressure or inherited heart weakness. At the moment only 105 of these patients have made it onto the heart-transplant waiting list because the number of available organs is so small. But could many more benefit from a pump?

The doctors crusading for their greater use are convinced that the life-saving possibilities of the new battery-operated devices have been under-researched to keep a lid on spiralling healthcare costs, and to ensure that talking up the pumps does not deal a potentially fatal blow to Britain’s struggling heart-transplant industry. They are keen that patients should have a range of treatments available and want to widen the debate, not narrow it.

There are also uncomfortable ethical issues that the campaigners would rather not address. The advent of electric heart pumps raises the possibility of thousands of wealthy old people demanding access to a new lease of battery-powered life. In the United States, Westaby’s innovation is proving popular with a growing number of over-75s. There are an estimated 1,000 battery-operated elderly Americans going about their business in the US. The record for the oldest patient to be fitted with one has just been set by an 87-year-old from San Diego. Because the research isn’t available, nobody knows how long these patients may live.

Back in the more prosaic world of the British NHS, the deaths at Papworth and Harefield have raised inevitable questions. Is the stock of good hearts decreasing? Are surgeons doing enough operations to maintain their skill levels? “There was no common factor to explain the deaths which occurred here,” said a Papworth spokesman. While awaiting the full results of their inquiry, Harefield say they see no obvious pattern emerging: their four deaths involved hearts from three different unidentified retrieval centres, with three different surgeons operating. In addition to Harefield and Papworth, specialist units in Newcastle, Manchester and Birmingham also receive heart-transplant patients. A handful more are occasionally carried out in Glasgow (three in the year to April 2008) and at Great Ormond Street children’s hospital in London, which did nine in the same year. Each centre employs up to five highly skilled transplant surgeons to give the requisite 24-hour cover. That means most of them are doing no more than four to six transplants a year – considerably fewer than, for example, liver- or kidney-transplant surgeons. The UK performs between 600 and 700 liver transplants a year and more than 1,300 kidney transplants.

Children currently have better survival rates than adults for heart transplants, and as yet there is no immediate possibility of a paediatric pump being made available to them. For around 30 youngsters a year, transplantation is their best chance of a span of extra life. Mike Burch, a senior cardiologist who is lead transplant consultant at Great Ormond Street, says he has used 16 heart pumps in children to keep them alive while they wait for a donor organ, but in none of these cases did the child’s heart stage the miraculous recovery seen in adult hearts relieved of the burden of pumping. He thinks donor- organ transplants will for some time remain the only option for children.

“We are getting at least 15 years of good-quality life for these kids before the donor heart starts to fail,” says Burch. “A lot of money has been put into this research in America, but we’re still a long way from a reliable paediatric device. A child forced to rely on an external battery, where you can’t play football or go swimming, would have no quality of life.”

Data on the true cost of every heart transplant are not available from the Department of Health, but a spokesman estimated that it was in the region of £300,000 for the cost of the operation and treatment in the first year, plus £10,000 in anti-rejection drugs and follow-up monitoring for every year a patient survives. This does not include the cost of nursing or of the bureaucracy provided by UK Transplant, the body that matches donors and recipients.

In comparison, pumps would appear to be a cheaper option. But are they as yet fit for purpose, and how easy are they to live with?

No surgeon wants to speak publicly of their misgivings about the future of the transplant programme, but one former transplant surgeon told me: “The number of donors has halved since the early 1990s, and that is not just because fewer people are killed on the roads. It’s because there is such pressure on hospital beds that they cannot be sacrificed for bodies destined only to become potential organ donors.”

Another pointed out that the glamour had gone out of the job: “Twenty years ago, if you did a transplant it made the news. Now they are considered old-hat. They have to be done at night, when operating theatres are empty. It’s hard, demanding work, and you’re still expected to turn up for 8am administrative meetings.”

“There is no money in it,” said a third heart surgeon. “They’re generally using hearts from older donors in worse condition, and if there is any excuse to reject an organ, surgeons take it.”

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