Status 4S

I recently learned something new about the status list for heart transplants. There is a new status created for patients with sensitivities.

Please keep in mind that I am not a specialist in this department and if you would like exact explanations refer to your medical professional. This is my interpretation only.

When a person is listed for a heart transplant they are rated at a particular status depending on their condition and urgency. Status 4 patients are in dire need of a transplant and the number goes down to Status 1 being the least urgent. I say "least urgent" but remember that those people are still listed for a heart transplant, so their situation remains significant.

In my understanding, all patients that receive an LVAD are in the condition of a Status 4 before they have surgery. I know that the surgeons wanted to wait about 5 days before implanting the LVAD in my case. They really only want a person to undergo 1 major surgery. Obviously, the VAD poses many other risks. I ended up only waiting 3 days because my condition was extremely dire. I expect this is the most common situation for other patients with a VAD.

After having the VAD implanted I am rated at a Status 3. My condition may seem "better" than others waiting for a heart but we must remember that the VAD has several potential life-threatening issues and my heart is essentially not working.

The new status is called 4S, for sensitivities. This is for patients waiting on the list that have antibodies. These antibodies are in women that have had children and people that have had blood transfusions. I am one of the lucky ones that did not develop antibodies after blood transfusions. As I understand, the donor's antibodies must match that of the recipient's. This is most often a difficult match. A recipient without antibodies can take an organ in both situations, from a donor with antibodies or without.

We are fortunate enough to have the technology at the tip of our fingers to determine what antibodies people have to give them the best chance post-transplant.

People with antibodies typically wait much longer for a transplant. That's why Status 4S was created. For example, if a heart becomes available that is suitable for donation a patient at Status 4S will be called as a first choice, probably without ensuring antibodies yet and a second patient that does not have antibodies will be called as a second choice. In case antibodies come up in testing, the organ can be implanted to the patient without antibodies, such as me. No organ goes wasted. If there was no Status 4S, that patient would not only have the wait the typical time expected for a heart matching in size and blood-type but also for a match with antibodies. A person with the Status 4S would also expect to experience more false alarms than a person without.

I hope I explained this properly. If you are a medical professional in this department and found that my interpretation is misleading, please make a comment. I appreciate your help.