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Infections in heart and lung transplant recipients are complex and heterogeneous. This article reviews the epidemiology, risk factors, specific clinical syndromes, and most frequent opportunistic infections in heart and/or lung transplant recipients that will be encountered in the intensive care unit and will provide a practical approach of empirical management., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Management of the cardiac transplant recipient includes careful titration of inotropes and vasopressors. Recipient pulmonary hypertension and ventilatory status must be optimized to prevent allograft right ventricular failure. Vasoplegia, coagulopathy, arrhythmias, and renal dysfunction also require careful management to achieve an optimal outcome. Primary graft dysfunction (PGD) can be an ominous problem after cardiac transplantation. Although mild degrees of PGD may be managed medically, mechanical circulatory support with extracorporeal membrane oxygenation or temporary ventricular assist devices may be required. Retransplantation may be necessary in some cases., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Renal complications are common following heart and/or lung transplantation and lead to increased morbidity and mortality. Renal dysfunction is also associated with increased mortality for patients on the transplant wait list. Dialysis dependence is a relative contraindication for heart or lung transplantation at most centers, and such patients are often listed for a simultaneous kidney transplant. Several factors contribute to the impaired renal function in patients undergoing heart and/or lung transplantation, including the interplay between cardiopulmonary and renal hemodynamics, complex perioperative issues, and exposure to nephrotoxic medications, mainly calcineurin inhibitors., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Lung transplantation, heart transplantation, and heart-lung transplantation are life-saving treatment options for patients with lung and/or cardiac failure. Evolution in these therapies over the past several decades has led to better outcomes with application to more patients. The complexity and severity of illness of patients in the pretransplant phase has steadily increased, making posttransplant intensive care unit management more difficult. Despite these factors and the pervasive complications of immunosuppressive therapy, outcomes continue to improve., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Aims and Objectives: To explore the experiences of spouses of heart transplant recipients and to consider how an understanding of these experiences may inform nursing practice., Background: There is a lack of knowledge about the experiences of spouses of heart transplant recipients during the pretransplant wait. Evidence suggests that spousal support improves post-transplant outcomes of heart transplant recipients; therefore, it is important to understand how nurses can improve spouses' psychological well-being during the pretransplant wait., Design: Integrative review., Method: A search of six electronic databases between November 2015-December 2015 and a hand search yielded 510 citations; nine studies met the review eligibility criteria. Inclusion criteria were applied to selected studies for review. Methodological quality of selected studies was evaluated, and data were extracted and compiled., Results: Six themes were identified: uncertainty, thoughts about death, changes to lifestyle and priorities, loss of sense of self, quality of life and learning to cope. Spouses experience high levels of stress caused by uncertainty about the patient's survival, increased responsibilities and changes to their lifestyle., Conclusion: The results reveal that the pretransplant period is all-consuming for spouses of heart transplant recipients. The impact of the pretransplant wait on spouses' well-being should be recognised by nurses, and improvements must be made in support and education available to spouses during the pre-transplant period., Relevance for Clinical Practice: There is a need for improved education about the transplant process, and reinforcement of positive coping strategies., (© 2016 John Wiley & Sons Ltd.)

Since the beginning of United Network of Organ Sharing data collection in 1987, a total of 8,333 pediatric patients have received a heart transplant in the United States. Because these patients now have longer graft success with improved care and immunosuppression, many of them are entering adolescence and young adulthood. Primary care pediatric nurse practitioners need to be alert to the prevalence of noncompliance with treatment in heart transplant patients, which continues to be highest in adolescence. Low compliance in adolescence increases morbidity, contributes to decreasing quality of life, and is the leading reason for graft failure and mortality in this age group. This article will review common barriers to treatment adherence in the adolescent heart transplant patient, discuss the role of the primary care pediatric nurse practitioner in preventing noncompliance, and review strategies that the primary care pediatric nurse practitioner can implement to improve compliance in this patient population., (Copyright © 2017 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Objetivo: To identify how the clinical and educational nursing care based on the Theory of Human Becoming can contribute to the transcendence process of heart transplant patients in pursuit of good living., Method: Research-intervention developed with four heart transplant patients linked to a reference transplant hospital in Ceara. Data was collected through interviews in 2014 and analyzed using Parse's theoretical framework and pertinent literature., Resultados: Transplant patients revealed they gave living in such condition an ambiguous meaning, showing satisfaction and dissatisfaction. Dietary restrictions, difficulties with medication and curiosity about the transplant were identified as disharmonies involving the process. Care was developed focused on educating the transplant patients, approaching the themes healthy eating, organ rejection, immunosuppressant use and facts about heart transplantation., Conclusion: Educative care based on Parse favors the decision-making and autonomy of individuals regarding their health, contributing to transcendence in pursuit of good living.

Heart failure impacts a multitude of individuals each year. Treatment is based on the progression of the disease and severity of symptoms. Cardiac transplant is the gold standard treatment of advanced heart failure, although the availability of organs limits the number of transplants received each year. Postoperative care and monitoring for cardiac transplant is complex and requires specialized nurses and providers at transplant centers for successful outcomes. This article outlines cardiac transplant from preoperative care through transplant, as well as posttransplant monitoring and care including discharge. Special attention is focused on management in the intensive care unit setting and potential complications that can occur in the immediate postoperative period. Interventions for potential complications are also highlighted.

Intra-aortic balloon pumps have traditionally been inserted via the femoral artery, limiting patients' activity and exposing patients to complications of immobility. For patients awaiting cardiac transplant, these complications may threaten a successful outcome, or at the least, complicate recuperation after transplant. A novel approach to insertion of balloon pumps via the subclavian artery is presented here, including routine nursing care, complications and related nursing actions, and experience with and advantages of this method. A team approach to care of these patients, including rehabilitation and exercise protocols, is recommended., (©2016 American Association of Critical-Care Nurses.)

Heart transplantation is a recommended and curative treatment option for patients with advanced heart failure symptoms despite receiving optimal medical and device therapy. The availability of donor organs limits the number of patients able to receive a heart transplant. The overall outcome of patients able to receive a heart transplant is determined by the successful delivery of essential nursing care. Understanding the specific interventions and therapies unique to this patient population is critical to their care. This article reviews considerations for the intensive care unit clinician in the management of heart transplant patients in this setting., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Over the past 20 years, solid organ transplantation has evolved from experimental treatments to an effective alternative for the treatment of various diseases, including heart failure. Treatment non-adherence is a limiting factor for the success of heart transplants. A systematic review of the evidence is needed to examine the effectiveness of interventions for managing adherence to treatment in heart transplant patients., Objective: The primary objective of this systematic review was to synthesize the best available evidence regarding interventions for managing adherence to pharmacological and non-pharmacological treatments in heart/heart-lung transplant patients., Inclusion Criteria: This review considered primary studies that included patients 18 years old or older, who had undergone heart or heart-lung transplantation (regardless of gender, ethnicity, comorbidities or whether they had received other treatments or not) who were receiving pharmacological and non-pharmacological treatments.This review considered studies that evaluated the effectiveness of interventions in managing adherence to pharmacological or non-pharmacological treatments among adult heart/heart-lung transplant patients. Primary studies comparing standard care with any type of intervention to maintain treatment adherence were considered.This review considered any experimental study design including randomized controlled trials; other research designs, such as non-randomized controlled trials and before and after studies, were also considered for inclusion.The primary outcome considered was patient adherence to pharmacological or non-pharmacological treatments by means of objective or self-report assessment., Search Strategy: Published and unpublished studies in English, Portuguese and Spanish were searched in electronic databases. Searches were completed in January 2014., Methodological Quality: Two independent reviewers, using the standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument, assessed methodological quality., Data Extraction: Data were extracted using the standardized data extraction tool from Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument., Data Synthesis: Statistical pooling was not possible due to substantial heterogeneity of the studies; therefore data were presented as a narrative summary., Results: Three quasi-experimental studies were included in this review. One study found that a dose reduction of immunosuppressive medications from a twice-daily to a once-daily regimen had a positive impact on treatment adherence; one found no significant difference in treatment adherence between patients who received educational intervention conducted in a teaching laboratory and those who received standard care; the third one also reported no significant difference in outcomes between a multifaceted intervention consisting of internet-based interactive workshops and standard care., Conclusions: The current best evidence to guide decisions regarding interventions to manage treatment adherence in heart transplant patients is limited. There is weak evidence that psycho-educational interventions (other than the standard care) has a positive impact on adherence and that decreasing the complexity of the treatment regimen by reducing the daily dose of the immunosuppressant drug improves adherence in heart transplant patients.

Aim: This article describes the rationale, design and methodology of the Building research initiative group: chronic illness management and adherence in transplantation (BRIGHT) study. This study of heart transplant patients will: (1) describe practice patterns relating to chronic illness management; (2) assess prevalence and variability of non-adherence to the treatment regimen; (3) determine the multi-level factors related to immunosuppressive medication non-adherence., Background: The unaltered long-term prognosis after heart transplantation underscores an urgent need to identify and improve factors related to survival outcomes. The healthcare system (e.g. level of chronic illness management implemented) and patient self-management are major drivers of outcome improvement., Design: The study uses a survey design in 40 heart transplant centres covering 11 countries in four continents., Methods: Theoretical frameworks informed variable selection, which are measured by established and investigator-developed instruments. Heart transplant recipients, outpatient clinicians and programme's directors complete a survey. A staged convenience sampling strategy is implemented in heart transplant centres, countries and continents. Depending on the centre's size, a random sample of 25-60 patients is selected (N estimated 1680 heart transplant recipients). Five randomly selected clinicians and the medical director from each centre will be invited to participate., Conclusion: This is the first multi-centre, multi-continental study examining healthcare system and heart transplant centres chronic illness management practice patterns and potential correlates of immunosuppressive medication non-adherence. The knowledge gained will inform clinicians, researchers and healthcare policy makers at which level(s) interventions need to be implemented to improve long-term outcomes for transplant recipients., (© 2014 John Wiley & Sons Ltd.)

A heart comes in many forms. This article shares the experience of behavioral health nurses caring for a suicidal patient who needs a heart. As a team, the nurses and their patient shared the journey of what it takes to achieve an optimum quality of life with a left ventricular assist device (LVAD) while battling mental illness.

Background: Post-heart transplant psychological distress may directly hinder physiological health as well as indirectly impact on clinical outcomes by increasing unhealthy behaviors, such as immunosuppression non-adherence. Reducing psychological distress for heart transplant recipients is therefore vitally important in order to improve not only patients' overall health and well-being but also clinical outcomes, such as morbidity and mortality. Evidence from other populations suggests that non-pharmacological interventions may be an effective strategy., Aim: The purpose of this study was to appraise the efficacy of non-pharmacological interventions on psychological outcomes after heart transplant., Method: A systematic review was conducted using the Joanna Briggs Institute methodology. Experimental and quasi-experimental studies that involved any non-pharmacological intervention for heart transplant recipients were included, provided that data on psychological outcomes were reported. Multiple electronic databases were searched for published and unpublished studies and reference lists of retrieved studies were scrutinized for further primary research. Data were extracted using a standardized data extraction tool. Included studies were assessed by two independent reviewers using standardized critical appraisal instruments., Results: Three studies fulfilled the inclusion and exclusion criteria, which involved only 125 heart transplant recipients. Two studies reported on exercise programs. One study reported a web-based psychosocial intervention. While psychological outcomes significantly improved from baseline to follow-up for the recipients who received the interventions, between-group comparisons were not reported. The methodological quality of the studies was judged to be poor., Conclusions: Further research is required, as we found there is insufficient evidence available to draw conclusions for or against the use of non-pharmacological interventions after heart transplant.

Cardiac transplantation remains a life-prolonging process. Survival after heart transplantation has improved despite a sicker incoming patient population. The field of heart transplantation is constantly evolving. Advances in organ preservation, immune monitoring, and improved immunosuppressive regimens will continue to develop over time. The impact of the newest immunosuppressive agents and protocols, improved diagnostic testing, and new management strategies is yet to be determined. The potential of cell therapy is still under evaluation and the field is still in its infancy but rapidly evolving; the key to the future in this field may not be the delivery of the cells themselves but understanding how they interact with one another at a molecular level and, in particular, with resident stem cells in cardiac tissue. In addition to the medical advances, health care professionals need to educate the public about the benefits of transplantation as well.

Cardiac and pulmonary transplantation has revolutionized end-stage heart and lung therapy. With the advent of cyclosporine and other immunosuppressive therapies, many patients lead productive lives. Unfortunately, other patients who have undergone cardiac and/or pulmonary transplantation do not have favorable results. In fact, some require retransplantation to live. Because of organ scarcity, healthcare professionals and patients must examine not only retransplantation survival rates but also the ethical considerations when dealing with resource-limited organs. Given that retransplantation survival rates are not as favorable as those for primary transplantation and that no studies involving quality of life and morbidity could be located, considerable thought should be given to this controversial practice.

Context: Very little research has focused on the long-term caregiving demands associated with parenting a child after a transplant or on the parents' perceptions of those demands., Purpose: To describe parents' experiences parenting a school-aged child after heart transplant., Design: Focused ethnography., Participants and Setting: Eleven parents of children who had undergone heart transplant 2 or more years before the study were recruited from a large children's hospital., Data Collection and Analysis: Parents were interviewed in a private location of their choice. Verbatim interview transcripts were analyzed by using content analysis and constant comparison., Results: The parents described their experiences in positive terms, yet acknowledged hardships. Key themes included (1) constantly responsible, (2) constantly worried, (3) constantly blessed, and (4) coping with life. The identified themes provide direction for interventions to help parents cope with the experience of parenting a child after heart transplant.

Aims: The aim of this study was to examine the rate of unplanned readmissions within the most recent postoperative year for heart transplant patients and the causes and contributing factors leading to such readmissions., Background: Advances in medical technology have significantly increased the survival rate of heart transplant patients. However, several postoperative complications make it common for patients to be readmitted to hospitals. An 'unplanned readmission' rate will better reflect the quality of postdischarge care than will mortality rate alone. Little research has been conducted on the heart transplant population in Taiwan., Design: Descriptive, cross-sectional., Methods: Data were collected from a purposive sample by structured questionnaires and medical record reviews., Results: Seventy-one patients were recruited at different times after heart transplantation. The unplanned readmission rate was 35.2% in the most recent postoperative year. The unplanned readmission rate was 52.2% for patients who had received transplantation five years ago or less, which was significantly higher than that for patients who had received transplantation more than five years ago (27.1%). Leading causes of unplanned readmission included infection (31.8%), rejection (25.0%) and cardiac allograft vasculopathy (18.2%). Blood urea nitrogen and creatinine levels were significantly higher in readmitted patients than in patients who were not (t = 2.09, p < 0.05 and t = 2.12, p < 0.05, respectively)., Conclusion: To reduce unplanned readmissions, the health professionals must continuously evaluate and monitor for adverse effects of treatment on patients, providing suitable guidance to equip the patient with the knowledge and ability to manage symptoms appropriately., Relevance to Clinical Practice: Continuous postoperative follow-up should be performed for patients. Nurses can function as the patient's evaluator, advisor, educator and advocator, to conduct postoperative care and carry out follow-up plans to prevent readmission.

For more than 40 years, cardiac transplantation has been a treatment option for patients with severe heart failure in whom optimal medical management is no longer effective. Critical care nurses are integrally involved in the care of patients with severe heart failure who may benefit from cardiac transplantation and are in a special position to recognize potential candidates for transplantation. Understanding patient selection criteria, the evaluation process, and how patients are managed while awaiting transplantation is key to the knowledge and skills required. It is also important to understand the allocation of donor hearts as part of this process. The waiting period for a suitable donor heart can be long and a patient's condition may deteriorate, requiring an increase in pharmacologic bridges with intravenous inotropic agents or mechanical bridges with circulatory assist devices. Critical care nurses become important as a personal bridge to transplantation through their education of patients and families and helping them cope with their fears during the waiting period. Critical care nurses who possess knowledge of patient selection and organ allocation processes along with the skills of caring for this complex patient population can contribute to better outcomes for patients with heart failure who may be candidates for cardiac transplantation.

Context: Medication nonadherence among adolescent heart transplant recipients can have overwhelming negative consequences including rejection and mortality. Because of issues specific to adolescents such as peer pressure, risk taking, independence, self-image, and self-esteem, they are a population susceptible to nonadherence. Adherence may be associated with a supportive environment, fewer physical and cosmetic side effects, and a sufficient knowledge of therapies. Adherence also may be related to regimens with fewer medications, predominantly fewer immunosuppressive drugs., Objective: To examine the differences in motivation between adolescents who are more adherent and those who are less adherent to their medication regimen following transplant surgery., Design: A descriptive design and mixed methodology, including a modified written survey, the Frazier Noncompliance Inventory; a self-report measure of overall medication adherence; and an interview designed by the investigator. Interview questions were reviewed for content validity by nurse clinicians and researchers., Setting: A heart transplant follow-up clinic in the southeastern United States., Results: Findings for 2 participants revealed striking contrasts in adolescent issues and factors affecting adherence. These findings are presented in a case comparison. Data show that a supportive environment and knowledge of medications were significant in increasing self-responsibility and adherence in adolescent transplant recipients. Also, experiencing rejection early in treatment because of less adherence led to increased adherence for fear of further rejections or death.

In the last 10 years more than 2,600 pediatric patients have received heart transplants. The survival rate at 10 years is 65% (Blume, 2003). There have been profound improvements in the survival and quality of life associated with pediatric heart transplants. Due to the increase in survival and quality of life, it is becoming more common for nurses to care for these unique patients. Nurses need to be aware of the complex management of pediatric heart transplant patients to aid in their care of these patients. This paper will discuss the transplant process, medications, common complications, and psychosocial impact associated with pediatric heart transplants to better prepare nurses involved in the care of pediatric cardiac transplant patients.

The study was aimed at evaluating the impact of educative health actions on nursing appointments with 18 transplanted heart clients, based on Orem's Theory. It was conducted in a Heart Transplant and Insufficiency Unit of a Public Health Institution in Fortaleza-CE. The data were collected by way of nursing appointments. 14 nursing diagnoses were identified in the first appointment and 7 in the last one. It was found out that the clients developed self-care skills with the implementation of educative health actions, tuming them into self-care agents, reaching a good level of health and well-being. On the other hand, it raised nurses' awareness of a systematic and efficacious management of the clinical monitoring of their clientele.

Heart transplants are a proven effective therapy for selected patients with end-stage congestive heart failure. But selecting patients, waiting, receiving and recovery can be a long and anxious process. This article provides an overview of heart transplantation and the nurse's role in helping the patient during this time.

Issues and Purpose: Inconsistent nursing practices created nurse-patient boundary issues on a cardiac step-down unit related to confidentiality, limit setting, and professionalism with patients and families awaiting organ transplantation., Conclusions: A staff work group designed and implemented a plan to translate the principles of therapeutic relationships into daily practice., Practice Implications: A work plan developed for nursing staff outlined concrete solutions and resources available within the hospital. This framework can be used to empower staff in the ongoing effort to manage relationships with chronically ill patients and their families.

While considerable progress is being made in the medical management of heart failure, mortality for this disease process continues to be significant. Cardiac transplantation becomes the treatment of choice for those with end-stage diseases that are acceptable candidates. While care of the cardiac transplant patient is similar to those recovering from cardiopulmonary bypass after sternotomy there are several issues unique to the cardiac transplant recipient. These include cardiac denervation, allograft dysfunction, management of arrhythmias, rejection, immunosuppression, and infectious complications. This article provides an overview of the postoperative management of the cardiac transplant recipient while in the intensive care unit. Additionally, a brief description of the surgical techniques employed and the physiology related to cardiac denervation are presented.

Cardiac transplantation is a recognized and lifesaving treatment for those unresponsive to all other available treatments (Hosenpud JD, Bennett LE, Kech BM, Boucek MM, Novick RJ. The registry of the International Society for Heart and Lung Transplantation: eighteenth official report-2001. J Heart Lung Transplant. 2001;20:805-815). The number of transplants performed in the United States grows steadily yearly with improving drugs for infection and rejection, the 2 most common medical complications and still the primary causes of death in long-term follow-up (Zugibe F, Costello J, Breithaupt M, Segalbacher J. Model organ description protocols for completion by transplant surgeons using organs procured from medical examiner cases. J Transplant Coord. 1999;9:73). Sometimes, getting the patient to the transplant process is in itself a struggle. As the need for heart transplants increase across the nation, donor hearts have not increased, even with more awareness in the medical community. Therefore, our struggle remains with keeping the patient alive, stable, and in the best position for transplantation when the perfect donor heart arrives. As critical care nurses, we see this bridge to transplantation in the form of pharmaceutical agents and/or mechanical assist devices (Scherr K, Jensen L, Koshal A. Mechanical circulatory support as a bridge to cardiac transplantation: towards the 21st century. Am J Crit Care. 1999;8:324-337). The patient waits patiently for a donor heart to be available, but is becoming weaker in the process. We wish to see those hearts come sooner and healthier. In truth, this in not usually seen. Sometimes the wish comes true, and with the help of nurses, doctors, ancillary departments, and even multiple hospital systems pulling together a miracle can still happen.

Pediatric nurse practitioners (PNP) confront numerous challenges when delivering care to infants, children, and adolescents who receive thoracic organ transplants. Today, thoracic organ transplantation is an acceptable and viable option for infants, children, and adolescents with end stage cardiac and pulmonary disease. Despite the plateau in the actual numbers of thoracic organ transplants performed annually in the United States, they are still being performed in a significant number. The care of children who receive transplants includes long-term use of immunosuppressants, dealing with infectious diseases, and utilizing principles of well child and family care. PNPs play a vital role in providing holistic care to infants, children, and adolescents who receive a thoracic organ transplant.

This article addresses an overview of patient education required for the postoperative heart transplant patient. The overall purpose of patient education is to insure the patient and, when appropriate, his or her significant other(s) are provided with education to enhance knowledge, skills, and behavior change. Patient education needs are to be continually assessed, identified, and addressed. Education includes instruction in the specific knowledge and skills needed by the patient and his or her significant other(s) to meet the patient's needs. Health education of the postoperative heart transplant patients may add significant and sustained benefits to their recovery and compliance with regime while reducing costs.

Orthotopic heart transplantation became more successful with the introduction of cyclosporine in the late 1970s. Although congestive heart failure has become a significant public health issue and the proportion of patients with advanced heart failure has increased, the number of heart transplants performed has not increased substantially in the past decade. Transplant waiting times have been related to many different factors. Unfortunately, implantation of ventricular assist devices (VADS) may provoke antibody responses. These result in the sensitization of patients and increased waiting time prior to transplantation. The purpose of this article is to explore etiologies of waiting times for pre heart transplant and left ventricular assist device pre heart transplant candidates, explain new theories of sensitization, define current methods to detect sensitization, and discuss nursing care implications.

Appropriate documentation of pre- and post-heart transplantation patient teaching has become increasingly challenging for the clinical nurse specialist (CNS) due to an increase in volume of referrals for heart transplantation evaluation, co-morbidities of those seeking transplant, complexity of the information that must be provided to candidates, demands by the Joint Commission on Accreditation of Health Care Organizations, and the compressed time for teaching, especially in the post-transplant hospitalization period. No heart transplant patient teaching documentation format was found in the literature that assisted us in overcoming these new demands. Using a center-developed Pre- and Post-Heart Transplant Patient Teaching Record, we describe a hypothetical case study to illustrate successful documentation by the CNS and the transplant team of the patient teaching plan of care.

Many organ transplant recipients experience organ rejection because they are noncompliant with the requirements of the health care regimen. The advanced practice nurse is in an ideal position to assess predictors of noncompliance as well as to implement interventions to enhance patient compliance. The purpose of this paper is to present a case study of a young female heart transplant recipient whose death due to organ rejection was related to noncompliance. The role of the advanced practice nurse in reducing noncompliance is identified and relevant nursing interventions are discussed., (Copyright 2003 CHF, Inc.)

The overall incidence of infection after transplantation has decreased with improved immunosuppressive agents, increased knowledge and use of prophylaxis, and better detection and treatment of infection. Nevertheless, infection continues to be a major cause of morbidity and mortality in heart transplant recipients. The knowledgeable nurse in any setting who cares for a transplant recipient must be aware of the lifelong susceptibility to common and opportunistic infections. The transplant recipient and his or her family must also be aware of the risks of early opportunistic infection. Infection is a lifelong concern for all persons on immunosuppressant medications, and the individual must learn appropriate precautions to reduce this risk. Hand washing and avoidance of infected individuals are the most important self-care actions that the transplant patient should adopt. Recipients must also learn to monitor for subtle signs of infection. The nurse is responsible for teaching self-care to patients and family members. Ultimately, a team effort by the patient, family, nurses, and physicians can reduce the risk of infection in this vulnerable population.

As more patients have a diagnosis of end-stage heart failure, nurses are more likely to encounter the use of left ventricular assist devices (LVADs). Currently, LVADs are used as a bridge to cardiac transplantation. However, current research suggests that LVADs may be used as destination therapy for those unable to undergo cardiac transplantation. The technology has been developed to sustain life, but what is the impact of technology on the quality of life? This article reviews current research on the quality of life with an LVAD.

In 1984 "Baby Fae" was the first infant to receive a heart transplant from a baboon. Though she only lived 20 days, her legacy began the movement to advance pediatric heart transplantation so that children with lethal heart disease could live to experience childhood. Sixteen years later more than 4,500 pediatric heart transplants have been performed in children ages 0 to 18. The International Society for Heart and Lung Transplantation reports a 79% survival at 1 year. 70% survival at 2 years. and 67% at 5 years for all ages and diagnoses. This article provides an overview of pediatric heart transplantation.

Cardiac transplantation is recognised as an effective treatment option for severe heart failure in carefully selected recipients. This article emphasises the importance of a multidisciplinary team approach and focuses on the first 24-48 hours of postoperative care. It discusses organ rejection; pain control; infection; psychological implications and rehabilitation. Survival rates and a brief history of transplantation are also provided.

Improvements in the treatment of heart failure have led to a fall in the number of people requiring heart transplants in recent years. However, there is still a shortage of organs, as the number of donors has also dropped. This article looks at the process for selecting cardiac recipients and the support offered to people awaiting a transplant. It also explains how a heart transplant is coordinated and outlines plans to increase the number of hearts made available for transplant.