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A heart transplant is the surgical replacement of a person’s diseased heart with a healthy donor’s heart. The donor is a person who has died and whose family has agreed to donate their loved one’s organs.
Since the performance of the first human heart transplant in 1967, heart transplantation has changed from an experimental operation to an established treatment for advanced heart disease.
People who have advanced (end stage) heart failure, but are otherwise healthy, may be considered for a heart transplant.
The following basic questions should be considered by you, your doctor, and your family to determine if heart transplantation is right for you:
If you answered “no” to any of the above questions, heart transplantation may not be for you. Also, if you have additional medical problems, such as other severe diseases, active infections, or severe obesity, you most likely will not be considered a candidate for transplant.
In order to get a heart transplant, you must first be placed on a transplant list. But, before you can be placed on the transplant list, you must go through a careful screening process. A team of heart doctors, nurses, social workers, and bioethicists review your medical history, diagnostic test results, social history, and psychological test results to see if you are able to survive the procedure and then comply with the continuous care needed to live a healthy life.
Once you are approved, you must wait for a donor to become available. This process can be long and stressful. A supportive network of family and friends is needed to help you through this time. The health care team will monitor you closely to keep your heart failure in control until a donor heart is found. The hospital must know where to contact you at all times should a heart become available.
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.
Donor hearts come from someone who is brain dead but still on life support. All other attempts at 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.
Various forms of heart disease can lead to transplantation, including but not limited to: <ul> <li>Congenital Heart Disease</li> <li>Ischemic and Nonischemic Cardiomyopathy</li> <li>Severe Angina (caused by Coronary Heart Disease)</li> <li>Coronary Artery Disease</li> <li>Congestive Heart Failure</li> <li>Valvular Disease</li> </ul>
Heart transplant surgery is not for everyone. Since donor hearts are hard to come by, strict rules are put in 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: <ul> <li>Severe kidney, lung, or liver diseases</li> <li>Pulmonary hypertension</li> <li>Continued use of smoking, drugs, or alcohol</li> <li>HIV</li> <li>Hepatitis</li> <li>Cancer</li> <li>Stroke</li> <li>Diabetes that has caused severe vital organ damage</li> <li>Active infection</li> <li>Malnourishment</li> </ul>
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 a 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 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.
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.
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.
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.
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 recommended 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.
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