Fairfax Hospital has applied to become the first hospital in the Washington area to transplant human hearts.
The request comes at a time when federal officials are trying to limit the number of new transplant centers and possibly close some of the nation's 72 existing centers.
Officials of Fairfax Hospital, the largest hospital in Northern Virginia, are planning to meet tonight with the Northern Virginia Health Systems Agency to seek approval for the new unit. The agency recommends to the State Department of Health whether a coveted "certificate of need" for new hospital services or expensive medical equipment should be granted.
"Our studies of the marketplace and population base show there is a need for heart transplants here," said hospital spokesman Lon Walls. "We've done so much open heart surgery already that we've got the capabilities." He said the hospital performed 653 open heart operations in 1984.
The hospital's application states there would be no new costs involved in creating the unit but notes that it would rely on Georgetown University Hospital in the District for tissue typing and other support services.
In its application, Fairfax Hospital said it plans to obtain donor hearts two ways: from trauma patients who die in its emergency room, and through an organ sharing network. It plans later to add a "harvest team" that would use the hospital's helicopters to fly to distant hospitals to obtain hearts.
According to figures from Georgetown University Hospital, more than 20 hearts from District and Northern Virginia hospitals were sent elsewhere for transplant in 1985.
The number of heart transplant centers needed in the country has been much debated. A recent federal study estimated that only about 20 heart transplant centers are necessary nationwide.
A federal Task Force on Organ Transplantation voted on Friday to limit government approval of heart transplant centers to hospitals that would perform at least 12 heart transplants per year, with survival rates of 72 percent in the first year. The task force also recommended granting approval only to hospitals that have kidney transplant programs.
These guidelines argue against the Fairfax proposal because the hospital has no transplant program and plans to perform fewer than 12 heart transplants during each of the first three years.
However, states are free to ignore the advice of the task force and the U.S. Department of Health and Human Services, which is trying to limit transplant centers by giving those payments to high-volume hospitals with high survival rates.
"Their advice is not binding, but these are the experts who have been convened to set up national guidelines," said an aide to Sen. Albert Gore Jr. (D-Tenn.), author of the National Organ Transplantation Act. "The theory is that centers wanting to do heart transplants should already have experience with immunosuppressant drugs," which reduce organ rejection.
The development of these drugs, such as cyclosporine, has created a boom in organ transplants. More than 500 hearts were transplanted last year in the nation, compared to an average of 30 yearly in the precyclosporine years of 1968 to 1981.
The hospitals nearest the Washington area that offer heart transplants are Johns Hopkins in Baltimore, which operates heart, lung and kidney transplant centers, and the Medical College of Virginia Hospitals in Richmond, which also transplant kidneys and livers.
Herb Teachey, transplant coordinator for the Medical College, said the proposed center at Fairfax would draw patients and donor hearts away from the Richmond center, which opened in 1968 and performed 44 heart transplants last year.
"We procure hearts in the Washington area, some from Fairfax Hospital itself," said Teachey. "We'd rather the patients come to Richmond because we have the capacity to expand."
Two consultants hired by Fairfax Hospital, while favoring the proposed center, noted two problems: The hospital lacks a transplant program and doctors with current transplant experience.
One of the hospital's cardiologists told a consultant that a Fairfax program is "unnecessary because too few patients would likely be treated" and because the programs in Richmond and Baltimore are sufficient.
Dindy Weinstein, director of an area health care monitoring group that includes employers, labor unions, hospitals and insurance companies, said she is concerned that other Washington area hospitals with large cardiac programs will become heart transplant centers.
"That's been a problem with three major jurisdictions and three sets of rules," said Weinstein, of the National Capital Area Health Care Coalition. "There is a need to regionalize all these high-tech services."
Washington Hospital Center, which performed more than 1,300 open heart operations last year, filed a letter of intent with District of Columbia health planners last month to apply for a heart transplant center. The hospital already has an active kidney transplant program.
Fairfax's request is the latest in a series of advances for the facility, hospital in 1961 and has grown into a major, 656-bed medical center. Because it serves a growing, affluent population of well-insured people, it has avoided many of the financial and labor problems plaguing many other hospitals, particularly those in the District.
In an era of falling occupancy rates, Fairfax has defied the experience of most hospitals and operates with 86 percent of its beds filled. Its obstetrics unit is so popular -- operating at 128 percent of capacity -- that women sometime go through labor in its hallways. One out of every 11 babies born in Virginia is born at Fairfax Hospital.