Heart transplant is a procedure where a failing heart is replaced with a healthy donor heart. It is usually recommended by doctors when all other forms of treatment – medical, interventional or surgical – have failed.
Heart failure requiring transplant can be caused by
- Cardiomyopathy – a disease of the heart muscles which weaken over time and it becomes increasingly difficult for them to pump blood to the rest of your body. A progressive condition, it is likely to ultimately result in heart failure.
- Coronary artery disease – Caused by narrowing or blockage of the coronary arteries due to fatty deposits. Again a progressive disease usually related to age, obesity, smoking habit or lifestyle complications like diabetes and high blood pressure
- Heart-valve disease – Sometimes one or more of our heart valves do not work properly thus disrupting the flow of blood to and from the heart. This can be a congenital defect or in adults can be a result of some infection or complication of some other heart condition.
- Congenital heart defect – A condition that exists from birth and may be detected later in life. It may involve the wall of the heart, valves, arteries or veins. It may be caused due to developmental abnormalities in the early stages of pregnancy or a result of certain infections like Rubella.
- Ventricular arrhythmia – Abnormal heartbeats that originate in the lower chambers of the heart (ventricles). This causes the heart to beat too fast and prevents the proper circulation of blood to the body. Overuse of caffeine, nicotine or other stimulants which cause the increase of heart beat may increase chances of this condition.
Heart Transplant is essentially the last resort treatment for heart failure. Though it is a complex procedure, the success rates are usually good. The patient would, however, need to work with the clinical and rehab teams in ensuring the success and be willing to make the necessary lifestyle changes like quitting smoking and consuming alcohol, follow regular exercise and balanced diet routines.
Heart transplant is usually not recommended in the following situations:
- In older people as advanced age can make recovery from the surgery difficult
- Presence of other medical conditions that are likely to shorten one’s life, like serious liver, kidney or lung disease
- If one has an active infection
- If one has a recent medical history of cancer
- Rejection of the donor heart by the recipient’s body is the most common cause of failure of the surgery. This is the result of the recipient’s immune system identifying the transplanted heart as an enemy. Immunosuppresant medications are prescribed by doctors to prevent this. Regular check-ups and heart biopsies are a must during the first year of the transplant to determine if your body is rejecting the new heart.
- Primary graft failure is a condition where the donor heart does not function
- Thickening of artery walls post transplant may occur in some patients and this can lead to further complications
- Long term use of immunosuppressants increases the risk of kidney disease and cancer. It may also make you more prone to infections
Preparing for the transplant
The heart transplant centre needs to have comprehensive heart treatment facility, including advanced critical care and rehab facilities
You doctor will evaluate your readiness for transplant based on the following
- You have a heart condition that will benefit from a transplant
- Are healthy enough to undergo the trauma of transplant and post surgery treatments
- Are willing to make the necessary lifestyle changes, including quitting smoking
- Are willing to strictly adhere to the treatment programme outlined by the medical team before, during and after the transplant
- Your emotional strength in handling the wait for a donor and post transplant treatment/complications
- Your network of family and friends who can serve as your support group who can help you deal with the stress
How is a donor match determined?
Donor match will depend upon your size, blood type and the seriousness of your condition.
While you are waiting for the donor your treating team would continue to monitor the condition of your heart and other organs. They may periodically change the medications and advise you on your dietary and exercise routine to keep you fit. If the ongoing treatment plan fails to support your vital organs as you wait, your doctor may recommend an interim device implant procedure. Known as ventricular assist devices, these are often referred to as bridges to transplantation.
Always be ready!
From the time of removal of a donor heart, one usually gets about 4 hours to complete the transplantation process. As soon as a match is established by your heart transplant centre, you shall receive a call from them. You need to be alert and ready to move immediately. At the hospital you shall need to undergo a final evaluation to ensure the suitability of the donor heart and your readiness for the surgery. You would be able to undergo the surgery only if all the parameters are found suitable. You shall need to undergo a pre-anaesthesia check.
Heart Transplant surgery is an open heart operation, done under general anaesthesia. It may take several hours depending upon the complications. You will be hooked up to a heart lung machine to keep oxygen rich blood flowing through your body. Your surgeon will then open you ribcage by making an incision in your chest to remove the diseased heart and sew in the healthy donor heart. The major blood vessels are then attached to the new heart to restore blood flow.
You will initially need to be on ventilator to help you breathe. You will be kept in the Critical Care Unit (CTVS – Cardiothoracic vascular unit) for a few days before being shifted to the ward. In the ward the rehab team will work with you to ensure faster return to fitness. Post discharge you will need to visit the hospital for regular follow-ups. You will need regular monitoring for signs of rejection of the donor heart by your body. Contact your doctor immediately if you experience, fatigue, weight loss or fever. You shall need to undergo frequent heart biopsies in the initial months post transplant to determine if your body is rejecting the donor heart.
Life-long Care Plan post Transplant
Please understand the success of the transplant surgery and your quality of life post transplant will depend a lot on sustaining the long-term adjustments you will be required to make.
Immunosuppressants are medications that decrease the activity of your immune system. You shall need to take them for life
Medications and lifestyle adjustments will become a part of your daily routine. Your doctor will advise you on the necessary adjustments you shall need to make in your diet and exercise routine, giving up all tobacco products, being careful to lower risk of infections.
Do not make any changes in your medications without talking to your doctor and keep him/her informed about any other health condition that may develop and you are prescribed a new medicine.
Cardiac rehabilitation is an important part of your recovery process. Specialized therapists will start working with you while you are in the hospital to help you get back to your normal routine and activities as soon as possible. You may need to continue the therapy post your discharge also for a while to ensure best outcomes.
Studies have shown the success rate of heart transplants is quite high, and most people experience a vast improvement in their quality of life. Some women with transplanted hearts have been known to go through successful pregnancies, but it is advisable to consult your doctor before planning a baby.
Medica’s Heart Transplant Programme
Among the most advanced in the region, Medica’s Heart Transplant Programme comprises highly skilled surgeons, critical care specialists, specially trained nurses and technicians, along with a cardiac rehab and nutritionists’ team. Dedicated operation theatres and CTVS unit fitted with latest life support and monitoring technology, provide comprehensive coverage and post transplant support. We also facilitate air-ambulance transfer of critical patients, nationally and internationally.