To date, more than 200 human heart-lung transplantations (HLT) have been performed in USA and Europe. The main indications are still primary pulmonary hypertension and Eisenmenger's syndrome but the intervention has also been employed in cases of parenchymatous pulmonary disease. At operation, the thoracic organ is replaced. The recipient's heart can frequently be donated. Recent reviews suggest acceptable two-year survival following HLT of approximately 60%. The direct economical costs of transplantation have been stated to be approximately 17,000 pounds but to this must be added the expenses for life-long immunosuppressive treatment and follow up control together with hospitalization during the time waiting for a suitable donor. The annual requirement for transplantation in Denmark is estimated at present to be approximately ten patients. The immediate requirement for transplantation will probably be covered by referral to the European centres via national or provincial hospitals and with the permission of the Danish Board of Health. The case reports of the first two Danes (both with emphysema secondary to alpha-1-antitrypsin deficiency) who underwent successful heart-lung transplantations in England are presented. In the long run, it will prove necessary to utilize Danish donors which necessitates alterations in the criteria of death.
The prehospital time interval in 103 patients with acute myocardial infarction was investigated. Twenty patients were admitted with cardiac arrest. In the remaining patients the average total delay was found to be 3.3 hours and the patient delay 1.5 hours. The total delay was significantly prolonged in patients who were admitted during working hours, patients who were unaffected on admission, patients transported for long distances, patients who had been visited by their doctors prior to admission and patients who contacted their own doctors. The authors find that attempts should be made to reduce these delays by means of information both to the public and to doctors.
