A heart transplant is a potentially life-saving operation that is often reserved for patients with end-stage heart failure or other serious cardiac disorders that are not amenable to additional medicinal or surgical therapy. When the heart can no longer pump blood efficiently enough to meet the body’s needs, a disease known as heart failure develops.
Possibly the most profound procedure performed in an operating room is a heart transplant. Each step requires considerable care, from the fast, meticulous journey to fetch the heart to the recipient’s preparation. In this blog let’s learn more about the surgery, its procedure, and some facts about it.
Common Causes of Heart Failure
Myocardial Infarction – It is a medical emergency commonly known as a heart attack. It happens when there is a decrease or complete cessation of blood flow in the myocardium causing chest pain and discomfort that spread to the arms, neck shoulders, and back. It can even result in death if not treated properly.
Hypertension – It is a condition that arises when the pressure of the blood on the arteries is too high, forcing the heart to pump harder.
Congenital heart disease – It refers to defects in the structure of the heart which is present since birth.
Arrhythmia – It is a problem associated with the rate and rhythm of the heartbeat. The heart may beat either too fast, too slow, or irregular.
Cardiomyopathy – It is a disease of the heart muscle that affects the size, shape, or thickness of the muscle
Chronic obstructive pulmonary disease – It is a common lung disease where there is restricted airflow leading to breathing problems.
Patient Selection Criteria for Heart Transplant
The process of organ donation is highly regulated to ensure the safety and compatibility of the donated heart with the recipient. Many more patients need heart transplants than the available deceased donor making it difficult to get the transplant surgery and a lot of people are on the waiting list. This list does not work on a first come first serve basis, instead when there is available donor heart, the candidates are matched based on certain factors such as medical urgency, distance from the donor hospital, and pediatric status. Generally, the candidate:
- Must have end-stage heart disease with a life expectancy of 12-18 months.
- Should have matching immunological status including blood type with the donor
- Should be younger than 70 years, though age is not a strict criterion and is flexible
- Condition should have failed to improve or stabilize with appropriate medical and device-based therapies, including medication, cardiac resynchronization therapy (CRT), or implantable cardioverter-defibrillator (ICD) therapy.
- Should be free from active infections, including hepatitis and HIV. Additionally, they should not have a history of certain cancers, such as metastatic malignancies.
- Organs such as the liver, kidneys, and lungs, should not be significantly compromised, as these conditions can affect the success of a heart transplant.
- should not have a history of substance abuse or drug addiction, and should be a non-smoker.
- May be free from severe comorbidities, such as uncontrolled diabetes or peripheral vascular disease
- Should undergo thorough psychosocial evaluation is conducted to assess the candidate’s emotional and psychological readiness for transplantation.
- Should have financial stability and insurance coverage are assessed to ensure that the candidate can afford post-transplant care and medications.
- Must have have a clear understanding of the transplant process, including the need for immunosuppressive medications and lifelong follow-up care.
Heart transplant surgery must not be done in people who
- Have infections such as hepatitis, HIV
- Have dementia and stroke
- Have a cancer history within the past few years
- Have diseases of the organ such as kidney, lung, liver, or nerve
- Have diseases such as insulin-dependent diabetes, pulmonary hypertension, and diseases that can affect the blood vessels of the neck and leg
In addition to the transplant surgery itself, there are other expenses to consider, such as preoperative evaluations, hospitalization, immunosuppressive medications, follow-up visits, and ongoing medical care. Heart transplant cost in India is often significantly more affordable than in many Western countries, although it will vary depending on the hospital, the location, and the specific requirements of the patient. It is advisable to explore insurance coverage options to help manage the costs. Some insurance policies may cover certain aspects of the procedure and postoperative care.
Eligibility Criteria To Be a Heart Donor
To carry out heart transplant surgery, the first requirement is a heart donor. To be eligible to be a heart donor, individuals must meet specific medical and ethical criteria which typically include the following:
- The heart donor must be a person who has been declared brain dead or whose heart has irreversibly stopped beating.
- Generally, the donor should be under 65 years of age. However this can vary based on individual circumstances, and the restrictions may be flexible if the donor’s heart is in excellent condition.
- The donor should not have a history of certain medical conditions, such as cancer, HIV, or active infections. This ensures the safety and suitability of the donor heart for transplantation.
- The donor’s heart should be free from significant cardiac diseases, such as coronary artery disease, cardiomyopathy, or other structural heart abnormalities.
- Donors must have negative blood tests for transmissible diseases, including hepatitis B and C, HIV, syphilis, and other infectious diseases.
- Donors should not have a history of substance abuse or drug addiction, as these factors can negatively affect the quality of the donated organ.
- The donor or their family must provide informed consent for organ donation. The decision to donate should be made voluntarily and without coercion.
Procedure For Heart Transplant Surgery
A heart transplant is a complex surgical procedure that typically takes several hours to complete. The operation is performed under general anesthesia to ensure the patient does not feel any pain during the process. The surgical site should be clean and sterile to prevent infection. The following steps are followed:
- An incision is made through the chest along the sternum (breastbone), to access the heart. During the surgery, the patient is connected to a cardiopulmonary bypass machine, which will oxygenates the blood and pumps it to the rest of the body while the surgery is performed.
- The pericardium is opened, and the ascending aorta and the main pulmonary artery are clamped to temporarily block the blood flow in and out of the heart.
- The damaged heart is carefully disconnected from the major blood vessels, and is replaced with the donors heart.
- Once the new heart is in place and functioning well, the machine is gradually withdrawn and the incision is closed with sutures or staples.
The patient is transferred to the intensive care unit (ICU) for postoperative monitoring and recovery. Vital signs, heart function, and overall health are closely observed. Immunosuppressive medications are given to prevent organ rejection.
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Risks Associated With Heart Transplant
- Bleeding during or after the surgery
- Blood clots that can results in heart attack, stroke, or lung problems
- Breathing problems
- Kidney failure
- Coronary allograft vasculopathy (CAV) – The blood vessels that carry blood to the heart muscle become thick and hard resulting into serious heart muscle damage.
- Failure of the donor’s heart
The success of a heart transplant procedure depends on the skill and coordination of the surgical team, the suitability of the donor heart, and the patient’s overall health. A year following surgery, 85 to 90 percent of heart transplant patients survive; after that, the annual death rate is about 4 percent. The success rate of heart transplant in India is generally in line with international standards. Heart transplant surgeries are performed at several well-established and reputable cardiac centers in India, many of which have experienced transplant teams and advanced medical facilities. Success rates can vary, but it’s not uncommon for recipients to experience improved quality of life and prolonged survival after a successful heart transplant. After the surgery, heart transplant recipients require lifelong medical follow-up and a strict regimen of immunosuppressive medications to prevent organ rejection. Close monitoring and postoperative care are critical to ensuring the best possible outcome.
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