Heart Transplant Overview The notion of transplanting a bad organ with a good one is not a recent procedure, rather it has been cataloged in classical folklores as well. However, the successful replacement of a human heart was not readily accepted among the medical community until the medications to prevent the donor heart from rejecting the organ was developed. |
A heart transplant is a surgical procedure performed to replace the heart of the patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed or are ineffective. It is a life-saving treatment to improve the quality and lifespan of the recipient.
The replacement of the heart is done when the heart of the patient is no longer capable to supply blood enriched with oxygen and other nutrients to other organs of the body. Besides, being a potential candidate to receive a heart is not enough. The recipient's immune system should be compatible enough to accept the donor's heart to reduce the chance of rejection. Also, it is necessary to undergo various tests to ensure that the recipient is healthy enough to go through the procedure of the transplant.
While there are many patients with end-stage heart disease along with deficient heart functioning, not all of them are eligible or qualify for replacement of the heart. To be eligible, all the other important organs in the body must be well functional. Patients with an active infection, cancer, or diabetes mellitus are considered poor candidates for the transplant. Also, the patients who have a history of consuming drugs, alcohol, or smoke are not considered fit for being a transplant recipient.
Severe coronary artery disease or end-stage heart failure is a condition in which the muscles of the heart have severe difficulty in pumping the blood even to the vital organs of the body.
It is a condition in which no other treatment modalities are efficient enough to support the patient. Failure of the heart can be caused by:
Heart attack (myocardial infarction or MI) Viral infection of the heart muscle High blood pressure Heart valve disease Heart defects present at birth (congenital) High blood pressure in the lungs Alcoholism or drug abuse Chronic lung diseases, such as emphysema or chronic obstructive pulmonary disease (COPD) Low red blood cell count (anemia) Dangerous recurring abnormal heart rhythms not controlled by other treatments Failure of a previous heart transplant A weakening of the heart muscle (cardiomyopathy) Coronary artery disease
The average cost of heart transplants ranges from 20-25 lakhs that includes pre-transplant evaluation, surgery, and the post-transplant recovery period. For heart transplants the doctors often suggest the patients check out their insurance plans for the coverage.
For receiving a heart transplant the patient must be placed on the transplant list first. Within four hours of removal of the heart the organ should be replaced into the recipient's heart. The team of doctors' monitor the patient's condition closely to control heart failure until the donor's heart is located.
Usually, the preparation to receive a donor's heart begin weeks before the heart transplant. It begins with the evaluation of the recipient patient for the transplant. This process includes:
Psychological and social evaluation. The factors like stress, financial issues, and support from family or significant others can greatly affect how well the patient does after the organ transplant. Blood tests. It is necessary to take blood tests to help find a good donor match and help improve the chances that the donor heart will not be rejected. Diagnostic tests. These tests are required to assess the lungs as well as your overall health of the patient. These tests may include X-rays, ultrasound procedures, CT scans, pulmonary function tests (PFTs), and dental exams. Women may get a Pap test, a gynecology evaluation, and a mammogram. Other preparations. Several vaccines are administered to the patient to decrease the chances of developing infections that can affect the transplanted heart. On the availability of the donor's heart, a surgeon from the transplant center goes to harvest or collect the heart of the deceased person. The heart is stored in a container with ice packs in a special solution for transport. The transplant surgery begins once the surgeon is ensured about the condition of the donor's heart.
The surgery is conducted under general anesthesia where the patient is put under a deep sleep. The anesthesiologist monitors the heart rate, blood pressure, and blood oxygen level during the surgery. During the surgery, the patient is placed on the cardio-pulmonary bypass (heart-lung machine) so that the blood is pumped within the body to all the organs of the body. The surgeon will then replace the diseased heart with the donor's heart and complete the procedure.
After the surgery, the patient is then transferred to the recovery room or the intensive care
unit (ICU) and monitored closely for a few days. A heart transplant surgery usually requires a stay of one to three weeks, depending on the condition of the patient. The patient will be monitored for infection, and medication management will begin. Antirejection medication is important to make sure that the body of the patient does not reject the donor organ. Also, the doctor can refer to a cardiac rehabilitation center or unit to help the patient adjust to his new life as a recipient of the transplant.
Recovery from a heart transplant can be a long shot process. To recovery fully can take a span of up to six months.
Care at Home
While the patient is shifted to a home setting it is important to take extra care of the patient. The points that should be considered include:
Keep the surgical area clean and dry. Not to disturb the surgical staples or sutures until removed by the doctor. Frequent follow-up visits with the doctor after the transplant. Tell the doctor right away if you have any of the following conditions: Fever, chills, or both. Redness, swelling, bleeding, or drainage from the incision site or any of the catheter sites Increase in pain around the incision site Trouble breathing Excessive fatigue Low blood pressure Potential Risks
As with any surgery, complications may occur. Potential risks involved with heart transplant may include:
Infection Bleeding during or after the surgery Blood clots that can cause heart attack, stroke, or lung problems Breathing problems Kidney failure Coronary allograft vasculopathy (CAV) Failure of the donor's heart Death Rejection
Rejection of any organ occurs the immune cells of the body attempts to destroy the transplanted organ as they look foreign or different from the own cells of the body. In such cases, the immune system rejects and starts to generate antibodies against the transplanted organs. Thus, if not treated the immune system would damage the cells of the new heart and eventually destroy it.
So, to prevent this rejection patients are prescribed immune-suppressants. These drugs prevent the immune system to reject the new heart and allows it to function normally. However, this suppressed immune system also makes the patient more prone to serious infections. To prevent this medications to fight against infections are also prescribed to the patients.
The possible sign for rejection or infection include:
Fever over 100.4°F (38°C) "Flu-like" symptoms such as chills, aches, headaches, dizziness, nausea, and/or vomiting Shortness of breath New chest pain or tenderness Fatigue or generally feeling "lousy" Elevation in blood pressure Pros and cons of the Procedure
The advantages of the procedure include:
It is a definitive treatment for end-stage heart failure. Good long term prognosis Good physical activity is achievable. Better quality of life with fewer defects in the heart. The disadvantages of the procedure include:
Donors are not readily available all the time. The heart transplant is an expensive procedure that is not affordable for each individual. Risk of transplant vasculopathy. Diseases can arise in the donor's heart as well. Susceptibility to infections and other chronic health problems. Issues related to the kidney due to immune-suppressants Life after heart surgery
After a heart transplant, the five-year survival rate for the organ is about 75 percent, according to the Scientific Registry of Transplant Recipients. It has been reported that patients feel better after the heart transplant. The recovery of the patients begins after the discharge of the patients. The steps that should be taken includes:
Regular Follow-up: it is generally advised to the patients to visit the doctor at a regular interval to monitor the progress of the recovery and condition of the new heart. In the beginning, the visits are more frequent, but they decline gradually.
Medication: to prevent the new heart from rejecting the patients are usually prescribed immune-suppressants along with other medications. Patients are thus in need to take these medicines for the rest of their lives.
Hygiene: practicing good hygiene practices along with adopting a healthy lifestyle is a must for the transplant patient.
Exercise: heart transplant patients are encouraged to exercise so that they can help adapt to the new heart and avoid weight gain as well. However, before resuming the exercise it is necessary to consult the doctor to avoid any sudden distress.
Diet: it is necessary to make some dietary changes post-surgery after consulting the dietician. Also, the patients are advised to take a low-sodium diet to decrease the risk of high blood pressure and fluid retention.
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