Aspectos organizativos contemporáneos del trasplante cardiaco: visión del clínico

Heart transplantation in Spain achieved maturity some time ago in terms of outcomes and the number of procedures performed. The main limitation has been a lack of suitable donors. This article reviews strategies currently under discussion for achieving progress in the field, whether by increasing the number of donors, by more rational selection of transplant candidates or by better planning at the national level. The emergence of mechanical circulatory assist devices, used either as a complement or an alternative to transplantation, is the single factor that will have the greatest influence on heart transplantation in the future. Heart failure is a common, chronic and complex condition, whose treatment requires the cooperation of different tiers within the health-care system at the national level. Formal regional networks that enable such cooperation must be established, beginning with the adoption of common terminology. Of particular relevance is the network established for the integrated treatment of cardiogenic shock. Finally, the ongoing training of specialists in the field should be recognized officially. The Spanish Society of Cardiology should take the first steps on the regulatory path towards establishing certification in this subspecialty – this will help harmonize practice in the field of heart failure in Spain with that in other developed countries.