What is a heart transplant?
A heart transplant is a surgery performed to remove a person’s diseased or damaged heart, which is then replaced with a healthy and suitable heart from a donor. It is a procedure reserved for patients with severe heart failure.
Where does the donor heart come from?
Donor hearts come from someone who is brain dead but still on life support. All other attempts of saving their life have failed before organ donation even becomes an option. A donor is someone under the age of 65 with little or no history of heart disease or trauma to the chest. Unfortunately, donor hearts are hard to come by.
What diseases can lead to heart transplantation?
Various forms of heart disease can lead to transplantation, including but not limited to:
- Congenital Heart Disease
- Ischemic and Nonischemic Cardiomyopathy
- Severe Angina (caused by Coronary Heart Disease)
- Coronary Artery Disease
- Congestive Heart Failure
- Valvular Disease
Who is not a candidate for heart transplantation?
Heart transplant surgery is not for everyone. Since donor hearts are hard to come by, strict rules are put into place when approving someone for candidacy. It is likely you won’t qualify for candidacy if you suffer or have suffered from any of the following:
- Pulmonary hypertension
- Severe kidney, lung, or liver diseases
- Continued use of smoking, drugs, or alcohol
- Diabetes that has caused severe vital organ damage
- Active infection
What should I expect when being evaluated for candidacy?
Once your doctor refers you to a transplant center, you will be evaluated by a transplant team-a group of specialists that will validate your candidacy. They will evaluate you on a physical and a mental level. This team is usually made of a cardiologist, a cardiovascular surgeon, a transplant coordinator, a social worker, a dietician, and a psychiatrist. An assessment of your finances will be performed, and expect for you and your family to be interviewed (this is just procedure to see whether or not you have good support system at home). Your medical examination will consist of tests to determine your overall physical condition. These tests can include but are not limited to: an EKG, echocardiogram, cardiac catheterization, liver tests, kidney tests, blood tests, skin tests, tests for cancer, exercise tests, dental examinations, pulmonary function tests, and tissue and blood typing to help prevent rejection. Other tests may also be performed to complete a more thorough examination.
If I am chosen as a candidate for heart transplantation, what happens next?
If you are dubbed a candidate for heart transplantation, you will then be put on the national wait list for a heart. While you wait for a donor heart it is vital that you keep up your health. You will receive on-going medical treatment for heart failure and other existing conditions that you may have. Your transplant team may have also administered suggestive diet and exercise plans to you. If this is the case, it is in your best interest to follow them and to also quit any further smoking, drinking, and drug use. Your transplant team will also perform routine tests and checkups to check your overall condition while you wait. A device you might consider receiving while you wait is called a ventricular assist device. A ventricular assist device is an implanted mechanical pump that helps your heart pump enough blood to the rest of your body. Many patients on the waitlist are very ill and this device is considered an effective treatment.
What determines my placement on the waiting list?
The wait-list for a donor heart is determined according to the blood type of the donor, size of the heart, the severity of illness of the recipient, and the geographic location of the recipient. When a donor heart becomes available, its information is typed into the UNOS computer and is compared to the wait list. The computer then comes up with a list of patients starting locally, and then spreading regionally, and finally nationally when need be.
What are the risks associated with heart transplantation?
The purpose of your body’s immune system is to fight off any foreign bodies, such as bacteria or viruses that may bring you illness. Your body will consider your new donor heart as “foreign,” and as such your body’s immune system will produce anti-bodies in an attempt to destroy them. This process is known as rejection. In order to prevent rejection, you will be put on medication by your doctor that will help slow and control this process. These same drugs will likely weaken your immune system, therefore leaving you more susceptible to infection. Rejection and infection are two of the major risks associated with transplantation. Other risks may result from long term use of the post-surgery medications you will be taking. Hardening of the arteries may also occur post-transplant and may lead to further surgery.
What is the surgical procedure for a heart transplant?
Before the surgery begins, you will be put into a deep sleep by general anesthesia. An incision is then made in the chest through the breastbone. Your diseased heart will be removed and in its place the surgeons will stitch the new and healthy heart. The blood vessels of your old heart will be reconnected to the donor heart, which should then warm up and begin to beat. If this is not the case, then the surgeon will try to start your new heart with an electric shock. During the entire process, you will be connected to a heart-lung bypass machine that does the heart’s work while yours is stopped during surgery. It sends out enough blood and oxygen throughout your body to keep your blood circulating. Once your new donor heart begins to beat, you will then be taken off of this machine. After surgery, tubes are entered into the chest to drain out any air, fluids, or blood, allowing the lungs to re-expand over several days. You may also be administered medication for a few days to help you sustain a regular heartbeat. Surgery for a heart transplant may take from four to six hours. Another type of heart transplant that may be performed is a heterotopic transplant. In this type, the surgeon will typically place the new heart on top of the old heart and just join them together.
How long is the average recovery period and when can I return to school or work?
After heart transplant surgery, the average person remains in the hospital for about 1-2 weeks. Once discharged, you will be required to make frequent trips to your hospital for the next three months for follow-up tests. During this time, you will be very susceptible to infection due to the medication, so it’s highly recommend you stay away from large crowds. After 3 months your doctor will decide whether or not your visits should become less often. The average person returns to an active and healthy lifestyle within 3-6 months post-surgery.
What medications will I be on after surgery?
Unfortunately, rejection is a common risk of transplant surgery. To help prevent rejection from happening, doctors will prescribe to you anti-rejection drugs (also called immunosuppressive drugs). These medications act by blocking the immune system to protect and preserve the new organ and its function. Cyclosporins, azathioprines, and corticosteroids are the three main types of immunosuppressive medications and are usually prescribed in a combination right after surgery. You may also be given antibiotics, vitamins, diuretics, or other medications.
Can complications arise from the medications I’ll be taking?
Long term use of immunosuppressants can unfortunately lead to complications. Unwanted side effects of post-transplant drugs are: high cholesterol, diabetes, osteoporosis, high blood pressure, kidney disease, liver disease, and some cancers. Immunosuppressants also affect your immune system, increasing your risk of infections. Discuss any concerns you may have with your transplant team.
What are the signs that my body is rejecting the new heart?
If you experience any of the following symptoms post-transplant surgery, it is important that you let your doctor know immediately. Early rejection is treatable.
- Unexplained fatigue
- Shortness of breath
- Weight gain or fluid retention (i.e., swollen knees)
- Fast or irregular beating of the heart
- Reduced amounts of urine
After surgery, what will be expected of me?
After surgery you will be put in the ICU and moved to a regular hospital room when appropriate. For the first three months after your discharge you will make frequent visits to your hospital for blood tests, chest x-rays, lung functions tests, and any other tests your doctors need to monitor your overall medical condition. If you’re doing well after those three months, your hospital visits will become less frequent. Overall, your main responsibilities will be to keep good diet and health and follow your doctor’s recommendations, such as following an exercise rehabilitation program. Taking your medications as prescribed is also essential to prevent rejection. What matters most is the health of your new organ.