Hearts on the Edge

Heart transplantation is a therapy reserved for patients with end-stage heart failure who no longer respond to optimal medical therapy or other interventions (transcatheter or cardiac surgical).

Among the most frequent causes that irreversibly damage the heart are:

  • Ischemic heart disease: obstructive disease of coronary arteries can cause heart attacks, leading to a reduction in the contractile capacity of the heart muscle.
  • Cardiomyopathies (dilated, restrictive, hypertrophic): primary disorders of the heart muscle that impair its ability to contract or relax.
  • Advanced valvular heart disease: when the heart valves (mitral, aortic, tricuspid) no longer function properly, the heart becomes overworked and may progress to irreversible heart failure despite correction of the valvular defect.
  • Complex congenital heart diseases: in some cases, even when corrected by cardiac surgery performed in childhood or adulthood, they may, over the years, lead to a reduction in the contractile function of the heart muscle.
  • Severe arrhythmias and right or left ventricular failure due to multiple causes that do not respond to therapy.

In all these cases, the heart is no longer able to pump enough blood to meet the body’s needs, resulting in progressive symptoms such as shortness of breath on exertion or at rest, edema, liver failure, and secondary kidney failure.

Hearts in Short Supply, Lives on Hold

Why more organs need to be “recovered” for transplantation

Around the world (including Italy), the problem is not only how to perform a transplant, but also how many hearts are available to do it. Waiting lists remain long: in Italy, about 800 people wait for a heart each year. In 2024, the total number of transplants reached a national record, yet the demand for organs still exceeds the supply. As a result, many patients spend months—sometimes years—waiting, with time gradually wearing down their strength.

To bridge this gap, the transplant network is working on two fronts: increasing donations and expanding the pool of “recoverable” organs. How? Padua has been at the forefront of these efforts, past and present.