SEE PAGE 1248 C ardiac transplantation remains the gold standard for heart replacement therapy for patients with end-stage heart disease. Although the absolute numbers of heart transplant procedures performed in the United States has grown in recent years, this modest increase has little epidemiological impact on the increasing prevalence of heart failure in a growing and aging population. Despite a record number of >3,000 transplants in 2016, >20,000 patients of the 3 million with advanced heart failure could potentially be eligible for heart replacement therapy (1,2). The donor organ shortage continues to limit cardiac transplantation’s therapeutic impact. Consequently, tremendous attention has been paid to finding ways to expand the donor pool. Efforts have included public awareness campaigns to increase the absolute number of potential donors, increased use of marginal donors, and, most recently, use of donor hearts following circulatory death. New industries are emerging focused on donor organ assessment and resuscitation. Ultimately, the greatest opportunity may lie in improving our selection criteria among the available donors deemed marginal. Consensus guidelines have been introduced to help guide clinicians, although supporting evidence is limited. Donor organs are commonly rejected for coronary atherosclerosis, ventricular hypertrophy, valvular disease, or the presence of prognostically unfavorable risk factors

中文翻译：

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创伤性大脑和破碎的心

SEE PAGE 1248 C 心脏移植仍然是终末期心脏病患者心脏替代治疗的金标准。尽管近年来在美国进行的心脏移植手术的绝对数量有所增加，但这种适度的增加对不断增长和老龄化的人口中心力衰竭患病率的增加几乎没有流行病学影响。尽管 2016 年有超过 3,000 例移植手术的记录，但在 300 万患有晚期心力衰竭的患者中，有超过 20,000 名患者可能有资格接受心脏替代治疗 (1,2)。供体器官短缺继续限制心脏移植的治疗效果。因此，人们非常重视寻找扩大捐助者库的方法。努力包括提高潜在捐赠者的绝对数量的公众意识运动，增加边缘捐赠者的使用，以及最近在循环死亡后使用捐赠心脏。新兴行业正在出现，重点是供体器官评估和复苏。最终，最大的机会可能在于改进我们在被视为边缘的可用捐助者中的选择标准。尽管支持证据有限，但已经引入了共识指南以帮助指导临床医生。供体器官通常因冠状动脉粥样硬化、心室肥大、瓣膜疾病或存在对预后不利的危险因素而被排斥 新兴行业正在出现，专注于供体器官评估和复苏。最终，最大的机会可能在于改进我们在被视为边缘的可用捐助者中的选择标准。尽管支持证据有限，但已经引入了共识指南以帮助指导临床医生。供体器官通常因冠状动脉粥样硬化、心室肥大、瓣膜疾病或存在对预后不利的危险因素而被排斥 新兴行业正在出现，重点是供体器官评估和复苏。最终，最大的机会可能在于改进我们在被视为边缘的可用捐助者中的选择标准。尽管支持证据有限，但已经引入了共识指南以帮助指导临床医生。供体器官通常因冠状动脉粥样硬化、心室肥大、瓣膜疾病或存在对预后不利的危险因素而被排斥