Heart transplants are no more part of science fiction fantasies. They are a clear reality in the current medical landscape. A heart transplant involves replacing a diseased heart with a donor’s healthy heart, especially in case of heart failure. Heart failure can be diagnosed by an Echocardiogram which measures the Ejection Fraction (EF) and by the rise of NT-pro BNP hormone in the blood as a response to the failing heart. In case of severe heart failure, the patient may need a heart transplant.
The patient is added in the government’s waiting list that is maintained for recipients awaiting Solid Organ Transplantation and the organ is offered according to the waitlist priority. The outcome of a transplant is determined by many activities undertaken by the team before and after the transplant and not just by the surgery alone.
Although a heart transplant is a major surgery, with proper follow-up care, the chance of survival is good. When you or your loved ones have to face with the decision to have a heart transplant, you should know what to expect from the entire transplant process including potential risks, follow-up care and the surgery itself.
What is the Process for donating the heart for transplant?
For heart transplant needs a heart donation from a person who is declared brain dead and is on a ventilator. Most transplant patients have to wait for a long time as there are more patients needing a transplant than there are deceased donors. Transplant patients are generally placed on the transplant waiting list. Contrary to many other waiting lists, the national transplant waiting list really does not work on the first-come, first served basis. When a donor’s heart is available, the transplant patient is matched based on three factors:
- Pediatric status
- Medical urgency,
- Distance from the donor hospital
Other crucial factors in the matching process for all organs include body size, blood type and other pertinent medical information.
How is Donor assessment and Recipient preparation done?
The brain dead donor is evaluated by a series of echocardiographic, hemodynamic, hormonal, bronchoscopic and infectious disease parameters, to assess the quality and safety of transplanting the organ into a recipient. Donor resuscitation is also carried out to improve the quality of the organ and transplant outcome, by a set of advanced therapeutic protocols administered to the brain dead donor. The recipient is also intensively assessed and kept in readiness for the impending transplant. Mechanical circulatory support devices like the ECMO and VAD are used for circulation in critically ill patients until the new organ becomes available.
What happens in Heart Transplant Surgery?
Once a donor heart becomes available, the heart is removed, cooled and stored in a special solution and the transplantation is performed at the earliest. During the surgery, the patient is placed on the heart-lung machine that allows the body to receive vital oxygen and nutrients from the blood even though the heart is being operated. The patient’s heart is removed except for the back walls of the atria of the heart’s upper chambers. The back of the donor heart is opened at the left upper chamber which is connected to the corresponding remnant of the recipient. The 2 large veins of the right side (venae cavae), are connected independently. The blood vessels are then connected, allowing blood to flow through the heart and lungs.
The Heart Transplant team includes specialists from:
- Cardiac surgery
- Infectious Diseases
- Critical Care
- Cardiac Anaesthesiology
How long does the surgery take?
It is a complex procedure that lasts for about 4 to 8 hours after the donor heart is recovered. Following the surgery, most of the recipients are on their feet within a few days and are discharged from the hospital in 10 to 15 days.
What are the Post heart transplant protocols?
A cutting edge transplant center has a surveillance system which meticulously follows up to prevent complications, such as infections, hormone imbalances causing diabetes and osteoporosis. Acute rejection is assessed by Endomyocardial biopsy and chronic rejection by an innovative Optical Coherence Tomogram, an investigation available only in a few of the centres worldwide.
A heart transplant is not just surgery but also a long and complex process starting with heart failure management, pre-transplant measures to assure the best results and a journey of compassionate and vigilant post-transplant surveillance.