Heart Transplant

When is Heart Transplant Performed?

A heart transplant is the last option and is performed when other treatments have failed. It is done in cases when of severe heart failure.

Heart failure is caused by:

• Dilated cardiomyopathy – A condition where heart is abnormally thickened, enlarged or stiffened (weakening of heart muscles)
• Severe coronary heart disease – Plaque buildup in the arteries with scarred heart tissue because of a heart attack
• Congenital heart defect – People with birth defects of the heart undergo heart transplant surgery
• Valvular Heart Disease – A condition where there is a defect or damage in one of the four valves of the heart
• Failure of previous heart transplant

Risks Involved with Heart Transplant

There are always some risks involved when undergoing a heart transplant surgery or any other surgery for that matter. Since heart transplant is a major operation, there can be certain complications that may show up immediately, while others may take a while to develop and get noticed.

The main risks associated with heart transplant are –

1. Rejection of the Donor Heart – This is one of the most common risks associated with a heart transplant. The immune system fights against foreign bodies and it attacks the donor’s heart after a heart transplant surgery. All patients who get a heart transplant receive immunosuppressants. These medications reduce and slow down the response of immune system and prevent it from attacking the donor’s heart. Rejection of donor’s heart usually occurs in days or few weeks. However, in some cases it can happen years later. Symptoms associated with rejection include:
   • Fatigue – Extreme tiredness
   • Aches and Chills
   • Severe Abdominal Pain
   • Palpitations – Irregular Heartbeats

   Doctors will screen the heart and determine if the patient’s body is accepting or rejecting the transplant. Frequent heart biopsies are performed to test heart tissues during the first year of the transplant

2. Immunosuppressants Side-Effects – A heart transplant surgery puts the patient on immunosuppressants which decreases the ability of their body to fight infections. Developing infections during this phase can be critical to health and special attention is paid towards suppressing the risk of infection. However, as soon as the body stabilizes, the quantity of immunosuppressants is decreased. Some of the other side-effects can include:
3. Graft Failure – Graft failure is a serious complication that occurs just after a heart transplant surgery is performed. It occurs when the donor’s heart fails and stops working.
4. Problem with Coronary Circulation and Arteries –Even after a successful heart transplant surgery, it is possible that the walls of arteries may thicken which can lead to cardiac allograft vasculopathy.

The Process for Getting a Heart Transplant in India

Getting a heart transplant in India is a long and extensive process that is carried out in various phases. The initial preparation and screening is carried out long before the actual surgery takes place.

1. Recipient Evaluation and Preparation – The First Steps
   Heart transplant is the last option for people with end stage heart failure.This surgery is not suitable for everyone and patients are carefully screened before they are referred for a heart transplant. The recipient of heart transplant is assessed on various parameters including:
   • Present condition of all organs
   • Presence of cancer cells
   • Infections and allergies
   • Diabetes
   • Lifestyle habits such as smoking or drinking

   If all organs are in healthy condition and the recipient is free from cancer or other infections, then the patient is screened further. Recipients who smoke, or drink in excess, or have chronic diabetes are often ruled out from a heart transplant. Once the recipient is found fit, their name is sent to the donor waiting list across the country.

2. Waiting for the Donor
   The wait for a donor’s heart can be short or long depending on the requirements, blood group and recipient’s number on the waiting list. It is difficult to predict how long a patient will have to wait for the donor’s heart. There is no order to the waiting list and recipients are matched with donors according to the best match possible. While the patient waits for the donor’s heart, it is imperative to take optimum care of the health.
   The donor’s heart is matched with the recipient on the following parameters:
   • Blood type
   • Size of the donor organ
   • Antibodies developed by the recipient
   • Time spent on the waiting list
3. Heart Transplant Surgery
   Surgery is conducted as soon as a donor’s heart is available for the recipient. Heart transplant must undergo within four hours of organ removal from donor’s body. When the recipient is notified, they must immediately act for a heart transplant surgery.

During the Surgery

Heart transplant is an extensive and critical surgery which can last for up to 6 hours. If the patient has previously undergone heart surgeries or has been a part of complications, the surgery time might exceed.

1. After opening the chest, a heart-lung machine is connected to the patient to keep the oxygen-rich blood flowing through the body.
2. Once the blood starts flowing in the body through the heart-lung machine, the recipient’s heart is removed, and the donor’s heart is sewn inside the body. Usually, the new heart starts working instantly as soon as blood flow is restored. In cases where it does not, an electric shock is delivered to kickstart the new heart.
3. Patient is kept on a ventilator and treated with medications till the situation is stabilized.

After the Surgery

After a successful heart transplant, the patient is kept under strict observation for a couple of weeks till the situation is deemed normal. During the stay at the hospital after a heart transplant surgery, the patient will undergo regular tests including heart biopsies, electrocardiograms, echocardiograms, lung function tests and more.

Since heart transplant surgery is critical, there are certain things that the patient must adjust to if they wish to have a successful heart surgery:

1. Medications – Heart transplant patients are given a host of different medications to stabilize their condition. Patients are also given immunosuppressants to prevent the immune system from attacking the donor’s heart. These medications might have some side-effects depending on the resistance of the patient.
2. Rehabilitation Program – After a successful heart transplant, the patient is advised to adjust to new lifestyle changes. The recipient is put on a diet and is encouraged to exercise. The cardiac rehabilitation program adjusts the recipient to these changes that are necessary for a faster and stable recovery.
3. Emotional Support –Once a heart transplant surgery is successful, the patient might need a whole new lease on life through emotional support. It is necessary to contain this overwhelming state which a patient is more likely to feel after a heart transplant.