A heart transplant can truly give a person their life back, however it is essential that due diligence is performed in order to get the best results from the procedure. It is also important that one consults with the best surgeons and cardiologists before making any important decisions.
Below is some information about heart transplants, so that you can at least begin to understand the subject.
The First Successful Heart Transplant
Let’s take a walk through history and take a look at the first human to human heart transplant surgery that was performed in 1967.While the surgery was initially a success, the patient did not survive, due to complications that evolved a short time after the surgery.
It was South African Surgeon – Christiaan Barnard who performed the first heart transplant. He prepared for this surgery by performing a number of experiments on dogs, before he and his 30 member surgical team began the procedure on a 53 year old South African grocer from Cape Town – Louis Washkansky. The heart of a young woman was used for the procedure – Louis was suffering from diabetes and heart disease that was determined as being incurable.
The heart donor was Denise Darvall, who was 25 and a bank clerk, unfortunately her heart became available when she was pronounced brain dead following a car accident.
The heart transplant was performed at Groote Schuur Hospital in Cape Town and was successful. The body accepted the heart, but the immunosuppressive drugs that he was given as part of the procedure affected his immune system and he became a victim of double pneumonia and died 18 days after the successful heart transplant surgery.
Post the first surgery a number of heart transplants were performed by Dr. Christiaan Barnard, and the survival rates only kept improving.
Orthotopic Heart Transplant Surgery
Let’s start with the basics. A heart transplant procedure involves replacing the failing heart of a patient with a healthy heart. As we are all aware, the heart is responsible for pumping blood all over the body. If the heart fails to function, it could lead to instant death, unless there is emergency medical equipment available. In some cases, the damage could be severe and beyond repair, even despite proper and quick use of the medical equipment. Patients in this condition can only survive if the damaged heart is replaced.
Patients who are lucky enough to get donor hearts will go through an Orthotopic heart transplant. An Orthotopic heart transplant takes hours and requires the involvement of heart specialists. The procedure needs to be performed under extreme care, as finding a match is very complex.
The surgery starts with surgeons opening up the chest to see the heart; the first step is removing blood vessels that lead to the faulty heart, thus detaching it from the body. During the surgery, the patient is connected to an artificial blood-pumping machine, which continues to pump blood through the body when the heart is detached. The donor heart is then placed inside the patient’s body, blood vessels intact. Once the heart is placed, the blood vessels are stitched on, to restart the heart. Electrical current is passed through the heart using paddles to restart it.
After the completion of the Orthotopic heart transplant surgery, the chest cavity is stitched up. The patient is then kept in the ICU and their condition is monitored. The first few days after the procedure are critical as a number of complications can arise after the surgery. In some cases, the patient will not accept
the heart, and this could lead to failure. If the patient sails through the first week without any complications, then they are said to be out of risk for Heart transplant rejection.
Orthotopic heart transplant surgery is a very complicated and serious procedure and both patient and surgeon have to apply extreme care. Patients cannot exert themselves for months after the procedure.
Heterotopic Heart Transplant Surgery
In a heterotopic heart transplant surgery, the patient’s heart is not removed. Instead, a new heart is placed adjacent to the original heart in a position that allows for connection of the chambers and the blood vessels, to form what is popularly known as a double heart. This gives the patient’s heart a chance to recover, and if there is a case of organ rejection, the second heart can always be removed. This procedure is only used in cases where the original heart is not able to function on its own.
Heart Transplant Statistics & Facts
A few facts can make the subject of heart transplant surgery easier to understand. Understanding why one needs a heart transplant surgery, what the process is, how donor hearts can be located, how long one may have to wait for a heart transplant, what does one do when a heart is available, what should be done in the interim and other facts and statistics can help the patient be better prepared to handle this difficult time in their life.
Allocation of Donor Hearts
It is sad but true, with heart disease on the rise, there are just so many more people who could benefit from the availability of healthy hearts. Given a great divide, a very serious selection procedure is followed to decide if a patient deserves to be put on the waiting list for a heart transplant. A team of doctors constituting of cardiologists, heart surgeons, social workers, transplant coordinators, psychiatrists and dietitians all coming together to make these critical decisions. There is a certain criteria that heart transplant candidates would have to meet, with the main items being:
1) The heart disease should be advanced and life threatening (patients may be at the risk of dying in the next one or maybe two years)
2) There should be no other feasible possibilities for treatment.
3) The patient’s heart should be the only problematic situation with the patient; they should otherwise be healthy to tolerate the strain of the surgery.
4) Candidates should be psychologically strong so as to handle the stress that comes with the surgery and the requirements for a change in their lifestyle
A few considerations that usually dismiss a patient from being put on the waiting list include:
1) The patient is older than 70 years
2) Liver, lung or kidney disease that is severe
3) Blood circulation problems
4) Pulmonary Arterial hypertension
6) Psychological problems that would interfere with taking care of the patient’s lifestyle after heart transplant.
7) Some severe infections or chronic diseases.
Once the candidate has been approved by the team, the patient’s name is put into a national registry, known as the United Network for Organ Sharing or UNOS. When an organ has become available, strict guidelines will be used to figure out which candidate will be eligible to receive the organ.
Waiting for a Heart Transplant
Waiting for the right heart can be a long and tiresome process. While some may not survive the waiting period, others may be removed from the waiting list due to development of different conditions, like cancer, infections, or other factors in the list above.
A heart usually becomes available when another individual is declared brain dead, in which case cardiologists need to ensure that the heart is healthy. The identification of a donor happens only when the person has specifically expressed the will to become an organ donor by way of signature. In some cases, family members can also allow for their loved one’s organs to be donated for transplantation. These specific requirements vary for different countries.
The National Institutes of Health cites the following success rates: 88% of patients are living one year after the surgery, 72% have lived up to five years, 50% have gone up to 10 years and 16% are alive up to 20 years after the surgery.