Heart Transplantation: Questions you always wanted to ask

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Heart Transplant is replacing a damaged or diseased heart with a healthy donor heart. It is not easy to find a donor heart. The donor should be brain dead but still on life support and the donor’s heart must match closely with the recipient’s tissue type or the body will reject it.

Why Heart Transplantation?

The following conditions of the heart may call for transplantation.
• Massive heart attack causing severe damage to the heart.
• Heart failure where medicines, alternate treatments and surgery is of no help.
• Abnormal heartbeats or rhythms that could be life threatening.

The Procedure:

The recipient is put into a deep sleep with general anesthesia and the breast bone is cut open for the procedure to be carried out.

• While the surgeon works on the heart, the blood is directed through a heart-lung bypass machine, which carries out the work of the heart and the lungs supplying the body with blood and oxygen.

• The diseased heart is replaced with the donor heart. The heart-lung machine is removed and the transplanted heart takes over its normal functioning of pumping the blood.

• Air, fluids and blood are drained out of the chest for several days, through tubes which are inserted in the chest allowing the lungs to re-expand fully.  

Who cannot take a Heart Transplant Surgery?

People who are malnourished, older than 65-70 years of age, HIV infected, stroke or Dementia patients, people with active infections such as Hepatitis, Insulin dependent Diabetes, malfunctioning of kidneys, lung, liver, nerves, pulmonary hypertension, smoking, alcohol or drug abuse are not eligible to take up this procedure.

Evaluation before the procedure:

Once it is decided to go for heart transplantation, the evaluation team will assess the candidate many times over several weeks or month which may involve blood tests and x-rays, skin check for infections, tests for kidney and liver, evaluation of heart such as EKG, echocardiogram and cardiac catheterization, tests for cancer, tissue and blood typing, ultrasound of neck and legs.

Follow up after the procedure:

The candidate should stay in the hospital for about 7 to 21 days after the surgical procedures. The first 48 hours will be spent in the ICU to monitor stability of the newly functional heart. The recovery period may last up to more than 3 months during which regular check-ups will be done.

The immune system in the body may consider the transplanted organ as a foreign body and may fight against the organ trying to reject it. Drugs to suppress body’s immune response are administered during this period. One can resume normal activities after 3 months. However rigorous physical activities should be avoided. Cardiac catheterization is done every year to ensure that no coronary disease develops later.

Prognosis:

It has been found that heart transplant prolongs life of people who would otherwise suffer premature death. The main concern of transplant is rejection, which if controlled can increase survival to more than 10 years.

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