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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.)

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.

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.

In conclusion, successfully bridging a Status 1 patient to the time of heart transplant requires a variety of skills. Vigilance is key in averting potential complications and addressing patient issues. Also, health care professionals will be called on to use their knowledge and expertise to deal with psychosocial and medical matters. When skillfully executed, the result of a successful transplant is an improved quality of life and a longer life. A successful transplant reflects a job well done by the professionals and is the ultimate goals for all of those who care for those who wait.

Since its approval by the USFDA in 1998, the LVAD has been used primarily as a bridge to transplantation. It has been effective in improving the overall health and debilitated states in patients with cardiomyopathies and CHF by restoring them to a near normal hemodynamic state and improving end-organ blood flow. Recent studies indicate that the LVAD might be useful as a destination therapy, making transplantation unnecessary, providing one solution to the imbalance of heart donor supply to transplant candidate need.

Heart transplantation presents an extremely stressful life transition for pediatric recipients and their families. The waiting period of the preoperative stage has been described as the most stressful aspect of the process. The stress and coping model of Lazarus and Folkman (1984) can be used as a conceptual framework for addressing stressors of pediatric transplant patients and their families. A case study of a preadolescent child awaiting heart transplantation in a hospital outside of a transplant center highlights common concerns, including feelings of isolation, depression, boredom, hopelessness, helplessness, exhaustion, lack of privacy, financial burdens, role strain, and family disruption. Psychosocial needs can be assessed and met, using a multidisciplinary approach. Because the preoperative stage can be stressful for nurses as well, the case study also explores the struggles of unit nurses trying to coordinate and manage the patient's care.

A battery-powered artificial heart--designed to replace the diseased heart both physically and functionally--is completing readiness testing in preparation for human trials. The initial goal is for the artificial heart to last 5 years, at which time a donor heart can be transplanted. No immunosuppression will be needed with the total artificial heart, and the recipient's hospital stay will be much shorter, resulting in a tremendous decreases in cost.