Nearly 20 years ago, clinical leaders in the field of heart transplantation met in Bethesda, Maryland, to address the growing disconnect between the numbers of patients with end-stage heart failure who were listed for cardiac transplant and those who actually received transplants. As stated by Dr Norman Shumway in his keynote address to the conference, "The principle issue that stands before us is the donor problem." The severity of the crisis at the time was reflected in the fact that more patients were listed on any given date than underwent transplantation in the previous year. In an effort to ease the supply-demand mismatch, conference leaders developed objective criteria for candidate listing and prioritization, suggested new strategies to improve survival on the waiting list, and broadened donor selection.
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