A heart transplant is a procedure in which a surgeon removes a diseased heart and replaces it with a donor heart. During a heart transplant, a mechanical pump circulates blood through the body while the surgeon removes the diseased heart and replaces it with a healthy heart from a recently deceased donor.
The heart transplant process starts when doctors refer patients with end-stage heart failure to a heart transplant center for evaluation. Patients found to be eligible for a heart transplant are placed on a waiting list for a donor heart.
Heart transplant surgery is done in a hospital when a suitable donor heart is found. After the transplant, patients are started on a lifelong health care plan involving multiple medicines and frequent medical monitoring
The first operation is harvesting the heart from the donor. The donor is usually an unfortunate person who has suffered irreversible brain injury, called "brain death". Very often these are patients who have had major trauma to the head, for example, in an automobile accident. The victim's organs, other than the brain, are working well with the help of medications and other "life support" that may include a respirator or other devices. A team of physicians, nurses, and technicians goes to the hospital of the donor to remove donated organs once brain death of the donor has been determined. The removed organs are transported on ice to keep them alive until they can be implanted. For the heart, this is optimally less than six hours. So, the organs are often flown by airplane or helicopter to the recipient's hospital.
The second operation is removing the recipient's damaged heart. Removing the damaged heart may be very easy or very difficult, depending on whether the recipient has had previous heart surgery (as is often the case). If there has been previous surgery, cutting through the scar tissue may prolong and complicate removal of the heart.
The third operation is probably the easiest; the implantation of the donor heart. Today, this operation basically involves the creation of only five lines of stitches, or "anastomoses". These suture lines connect the large blood vessels entering and leaving the heart. Remarkably, if there are no complications, most patients who have had a heart transplant are home about one week after the surgery. The generosity of donors and their families makes organ transplant possible
After a heart transplant, the recovery process is similar to the process after other heart surgeries. People who receive transplants often need a cardiac rehabilitation program, because long-term heart failure is usually present.
You will spend about 4 to 8 weeks in the hospital after surgery, both for starting rehabilitation and monitoring the transplanted heart and for treating rejection if it occurs
A heart transplant is indicated only in the following situations:
The person has end-stage heart failure, ischemic heart disease, cardiomyopathy, or congenital heart disease.
The person has less than a 50% chance of living as long as 1 year without a heart transplant.
The person has no other serious medical conditions that would reduce his or her life expectancy.
The doctor strongly expects that a heart transplant will increase survival and improve the person's quality of life.
At some centers, transplant candidates must demonstrate that they have quit smoking and/or overusing alcohol for a period of time (such as 4 to 6 months) before they are considered for placement on a transplant waiting list.
To check for rejection, every 3 to 4 months surgeons test a sample (biopsy) of the heart tissue and also perform echocardiography, electrocardiography (ECG, EKG), or blood tests.
If your body rejects the heart, you will receive additional drugs (such as immunosuppressant or steroids) to suppress your immune system so that it does not reject the donor heart. These additional drugs may have serious side effects, including an increased risk of infections and cancer.
Other risks, such as:
Side effects (for example, infections, ulcers, or bone loss) that may occur from steroid therapy used to suppress the immune system.
Side effects that may occur from a drug (cyclosporine) given to prevent rejection of the donor heart.
Clogging of the arteries (atherosclerosis) that may develop in the donor heart. (This is usually a complication and is an important limiting factor that affects long-term survival.)
Heart transplants are done as a life-saving measure for end-stage heart failure when medical treatment and less drastic surgery have failed. Because donor hearts are in short supply, patients who need a heart transplant go through a careful selection process. They need to be sick enough to need a new heart, yet healthy enough to receive it.
Survival rates for people receiving a heart transplant have improved over the past 5 to 10 years—especially in the first year after the transplant. About 88 percent of patients survive the first year after transplant surgery, and 72 percent survive for 5 years. The 10-year survival rate is close to 50 percent, and 16 percent of heart transplant patients survive 20 years.
After the surgery, most heart transplant recipients (about 90 percent) can come close to resuming their normal daily activities. However, fewer than 40 percent return to work for many different reasons.
When all potential problems are considered, the results of transplantation are remarkably good. Keep in mind that heart failure is a very serious and life-threatening disease. In patients with severe forms of heart failure that require transplantation, the one year mortality rate (that is the percent of patients who die in within one year) is 80%. Overall, five year survival in patients with any form of heart failure is less than 50%. Compare these outcomes with cardiac transplant. After heart transplant, five year survival averages about 50%-60%. One year survival averages about 85%-90%.
How does a heart transplant patient know if he or she is rejecting the donor organ or developing an infection?
This is not an easy question to answer because many of the symptoms and signs of rejection and infection are the same. These include:
malaise (feeling lousy),
"Flu-like symptoms", such as chills, headaches, dizziness, diarrhea, nausea and/or vomiting.
The more specific symptoms and signs of infection will vary greatly depending upon the site of infection within the body. Transplant patients who experience any of these findings need to seek medical attention immediately . The transplant physician will then do tests to determine whether the transplanted heart is functioning normally or not. If there is no evidence of rejection, a thorough search for infection will be performed so that the patient can be treated appropriately.