Waiting For a Heart Transplant
The ultrasound tech stopped me as he was leaving the ICU. “I’d be careful with him,” he said, “otherwise you’re going to have a cardiac arrest on your hands.” He paused to give me a disappointed grimace, “his ejection fraction is less than 5%.”
One of the ICU nurses leaned into the conversation, “You’re going to talk to him about hospice, right?”
“He doesn’t want hospice,” I told her. “He’s hoping for a new heart.”
Heart failure is a medical condition in which the hearts no longer pumps well. As a result, the body doesn’t move blood appropriately and fluid begins to back up. This often results in swollen legs, fatigue, and fluid in the lungs that leads to difficulty breathing. This is a chronic condition that, particularly when left untreated, will continue to progress, can be incredibly debilitating, and is associated with high mortality risk.
There are multiple types of heart failure, typically classified by a “reduced” or “preserved” ejection fraction. An ejection fraction (EF) is evaluated by an ultrasound of the heart and evaluates a percentage of how much blood in the left ventricle (the biggest and final chamber of the heart) is pushed out towards the body with each contraction. A normal ejection fraction is typically between 55-70%. This value can be used as an indicator of how well your heart is functioning and can be used to help diagnose and monitor heart failure.
This particular patient, with an ejection fraction of only 5%, had advanced heart failure. His heart was barely moving blood through his body at all. And the ultrasound tech was correct—he was at very high risk for a sudden cardiac arrest with even the slightest bit of stress on his heart. When heart failure with reduced EF has progressed this far, there is little hope of improving the patient’s condition beyond using basic medications to optimize their comfort and (hopefully) to maintain what little function their heart has.
Yet, in cases such as these, some patients choose to place their hope in drastic measures—some even consider heart transplants or artificial pumps (such as a Left Ventricular Assist Device). While these are extreme measures, it makes sense that when all else is lost these patients place their hope here. Some studies show that a heart transplant, when successful, can significantly improve not only life expectancy but also functional status and health-related quality of life. Even with severe health, they have somewhere to place their hope.
Israel Longs for New Hearts
Like this patient, the Israelites were all people waiting for heart transplants.
Jeremiah wrote “’The days are coming,’ declares the LORD, ‘when I will fulfill the good promise I made to the people of Israel and Judah.’ (Jeremiah 33:14). In the well-known text of Isaiah 9 there was also the promise of a Messiah figure—one who would come from the line of David bring about a restoration. But this was a promise made long before both Isaiah and Jeremiah’s day.
For generation after generation the Israelites had been promised the coming of a Messiah and hoped for the resurrection that He would bring—not only to creation but to their own hearts as well. They cried out for this again and again. In Psalm 51 David pleaded for a new heart, saying, “Create in me a clean heart, O God, and renew a right spirit within me” (Psalm 51:10).
They had good reason to ask for this—for God had promised it. In the midst of the horrifying texts of Ezekiel, hidden between words of judgement and blood-shed, God promised heart transplants to his people. He said “I will give you a new heart, and a new spirit I will put in you. And I will remove the heart of stone from your flesh and give you a heart of flesh. And I will put my Spirit within you, and cause you to walk in my statutes and be careful to obey my rules. You shall dwell in the land that I gave to your fathers, and you shall be my people, and I will be your God” (Ezekiel 36:25-28).
Advent Hope for a New Heart
The Israelites waited in exile with their broken, bleeding, battered hearts for this promise. They waited as my patient did, with anticipant hope that one day new life would come to them. They knew that their hearts were failing them time and again, and that at any moment their hearts could stop all together.
We are reminded of that waiting in this Advent season. But joyously we are reminded that though we sit in our brokenness now, the New Testament tells us the result of this waiting. We know that through the birth of Christ—the Messiah made flesh—the Israelites’ plea for a heart transplant did indeed come true. Christ has come! We have been restored and redeemed. Our hearts now beat in our chests with the joy of the Messiah who has come at last!
Hold On To Christ’s Hope
Yet, we are still living in a season between the first creation and the renewed creation. We are living between Advents. Our hearts, though restored, still long for the day when they will beat without worry—when they will be restored by Christ completely in the renewed creation.
Heart failure is one of many chronic illnesses. Many of these chronic illnesses have a long list of medications and treatments that can be used to help prevent progression of illness or even provide some symptomatic relief. Unfortunately, in most of these cases, this does not mean complete restoration of health.
What I have found during my time in the medical field is that those with chronic illnesses can sometimes lose their hope. When they are first diagnosed, they search for every treatment option and plan available. They hungrily seek resolution to their symptoms and their grief. But with time often comes ambivalence. Eventually, the chronically ill stop waiting—at least, they stop waiting with hope.
Our circumstances between the two Advents (Christ already come and the promise that Christ will return again with His glorified New Creation) can sometimes feel like a chronic illness. It can feel like heart failure treated with medications and no hope of a true heart transplant. We think: if Christ has already come and the world is still this broken, then is there yet hope that we can be fully healed?
Dear Christian, please continue to wait with anticipation—place your hope in the One who has redeemed you, that some day your heart will be made whole. And as you wait, may your heart beat in the sure and steady confidence of the Messiah who has redeemed you and who will one day come again to His glorious praise and honor.
-Mariellen (December 2023)
Resources:
American Heart Association. “Ejection Fraction Heart Failure Measurement.” American Heart Association. 06.14.2023. https://www.heart.org/en/health-topics/heart-failure/diagnosing-heart-failure/ejection-fraction-heart-failure-measurement#:~:text=Ejection%20fraction%20(EF)%20is%20a,pushed%20out%20with%20each%20heartbeat.
Colucci et al. “Clinical manifestations and diagnosis of advanced heart failure.” UpToDate. August 10, 2022. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-advanced-heart-failure?search=heart%20failure&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
English Standard Version – Psalm 51:10, Isaiah 9:2-7, Jeremiah 33:14, Ezekiel 36:25-28, 2 Corinthians 5: 17, Hebrews 10:22
Heidenreich et al. “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.” American Heart Association Journals. Volume 145. Issue 18. May 3, 2022.
King et al. “Diagnosis and Evaluation of Heart Failure.” American Family Physician. 2012;85(12):1161-1168. https://www.aafp.org/pubs/afp/issues/2012/0615/p1161.html
Proverbs 19:21 