In India, heart transplant procedures have a success rate of up to 90%. Learn about heart transplant surgery, its eligibility criteria, risks, complications, rejection rates, and more.
What is a heart transplant?
Why is the heart so important?
The heart pumps blood that circulates to all parts of the body. It consists of two upper chambers called atria and two lower chambers called ventricles. The atria (singular: atrium) and the ventricles are further divided into right and left chambers. These four chambers are connected by valves that control the flow of blood.
When the heart begins to fail, the body’s other organs — the lungs, kidneys, liver, and brain — fail to receive blood oxygen and other important nutrients and get damaged.
Who needs a heart transplant?
This procedure is recommended for patients suffering from end-stage heart failure when other methods of treatment are unsuccessful. These conditions are usually one of the below:
- Congestive heart failure: In this, condition heart fails to pump blood efficiently. Advanced heart failure has a 70-80% chance of death if left untreated
- Inoperable congenital heart disease: This is a condition where the heart or blood vessels near the heart do not develop normally before birth and cannot be surgically corrected
- Coronary artery disease (CAD) is the narrowing or blockage of the blood vessels in the heart. These blood vessels, called coronary arteries, supply oxygen and nutrients to the heart and if they are severely blocked beyond the point of repair, a heart transplant may be a treatment option
- Malignant arrhythmias, or irregular heart rhythms that are resistant to treatment
Who is an ideal candidate for a heart transplant?
Heart transplantation is recommended for end-stage heart disease patients when all other treatment options have failed. However, the patient must still be healthy enough to undergo the surgery and receive the transplant.
The eligibility criteria for heart transplantation are as follows:
- The patient should ideally be under 65 years of age (exceptions should be approved by the transplant committee)
- The patient must not have any habits of substance abuse such as smoking, drinking alcohol, or using narcotics
- Absence of other medical conditions (liver, kidney disease, terminal malignancies)
Normal liver, kidney, and lung function - The patient should not have suffered from any mental illness or cancer in the last 2 years, osteoporosis, spinal deformity, or sepsis (a severe infection)
- The patient must not suffer from any active HIV, hepatitis B, or hepatitis C infections
What tests should the recipient undergo if he is receiving a heart transplant?
If you fulfil the initial eligibility criteria, you will then be asked to undergo the following medical tests to ensure that you are healthy enough to receive the transplant and that your body can cope with the procedure:
- Heart evaluation tests
1.electrocardiogram (ECG)
2.echocardiogram
3. cardiac catheterisation - Bone mineral density test
- Chest X-ray
- Blood and skin tests to check for infections
- Blood tests to assess kidney function and liver function
- Complete blood count (CBC)
- Tissue and blood typing for matching against potential organ donors
- Ultrasound of your neck and legs
- Tests for early signs of cancer (where necessary) –
1. Pap smear: to test for cervical cancer
2. Mammogram: to test for breast cancer
3. Colonoscopy: to test for colorectal cancer
If you undergo the required tests, you may be required to spend two to three nights in the hospital for the examination process. It’s recommended to have someone accompany you to the hospital and make sure you keep them informed about the process.
What happens after I fulfill all the eligibility and medical criteria for a heart transplant?
If you fulfill the eligibility criteria for heart transplantation and if the results of all your medical tests are satisfactory, you will be added to a waiting list to receive a transplant. Your position on the waiting list is determined by the following factors:
- the type of heart condition you are suffering from
- the severity of the heart condition
- the likelihood of the heart transplant being successful
While waiting for the transplant, continue consulting with your cardiologist and adhere to the medication regimen prescribed by them.
What happens when a donor heart becomes available for transplantation?
When a donor becomes available, the suitable candidate who is first on the waiting list will be selected and contacted. The specialists and surgeons will take into consideration the following factors to match the recipient heart with the donor heart:
- If the size of the donor’s heart matches that of the recipient with no more than 20% variability
- Whether the blood groups of the donor and recipient are compatible
- Tissue typing is a test that matches the type of donor cells to the recipient. It is conducted to further ensure that the donor organ will be accepted by the recipient
- Other factors such as the ages of the donor and recipient (if a young recipient receives a heart from an old donor, their quality of life may be reduced when compared to that of a younger donor)
What are the types of heart transplants?
There are two kinds of heart transplant procedures:
- Orthotopic heart transplants : This is the most common type of procedure. It involves the removal of the recipient’s damaged heart and introduction of the donor’s heart in its place. The transplanted heart is placed in the normal anatomical position
- Heterotopic heart transplants (piggyback transplants ): This is rarely done. The diseased heart is retained and the donor heart is connected to it. The donor’s heart acts like an assistant and can be removed in the event of a severe transplant rejection.
How do I prepare for heart transplant surgery?
A multidisciplinary team of professionals consisting of cardiologists, transplant surgeons, anesthesiologists, intensivists, transplant coordinators, nurses, social workers, a psychiatrist or psychologist, and a dietitian will guide you through the process. You will also be assigned a transplant coordinator who manages your transplant procedure and follow-up care.
The transplant team will brief you about the surgery and answer any questions you may have. You’ll be required to not eat or drink anything for up to 8 hours before the surgery.
You’ll sign an informed consent form that tells you about the details of the procedure, including the risks and complications involved.
You will be asked to remove your clothing, jewellery, and other objects that may interfere with the procedure and change into a hospital gown.
What happens during a heart transplant procedure?
Heart transplantation is an open heart surgery. You will be given general anaesthesia, which means that you will sleep through the whole procedure. You will be connected to a heart-lung bypass machine to ensure that oxygen-rich blood is circulated through the body during the procedure.
- A cut will be made on your chest, your chest bone will be separated, and your rib cage will be opened by the surgeon
- Your diseased heart will be removed, and the donor heart will be introduced in its place. Your major blood vessels will be attached to the new heart
- The transplanted heart will start beating once the blood flow is restored. Sometimes an electric shock may be required to initiate it
- The incision made for the transplant will be closed
- You will be given pain relief medicines to relieve pain
- You will be connected to a ventilator to help you breathe, and you will have a tube in your chest to drain the fluid from your lungs and heart
- You will receive medicines and fluids through a drip (intravenous line)
What happens after the heart transplant surgery?
After the transplant, you will be taken to a recovery room or the intensive care unit (ICU) and kept under observation for 1-2 weeks.
Once you are allowed to go home, you will be given instructions to comply with strictly:
- Keep the area dry and clean
- Refrain from driving vehicles until your doctor permits you to do so
- Avoid lifting anything heavy, pushing or pulling on heavy doors or furniture
- Avoid strenuous activities such as tennis, bowling, and heavy housework
Stay in touch with your transplant coordinator. Regularly follow up with your cardiologist and transplant team to monitor your progress.
What are the risks of a heart transplant?
Like all procedures, there are some risks associated with heart transplants:
- Blood clots (deep venous thrombosis)
- Damage to the kidneys, liver, or other organs from medicines given to prevent transplant rejection. These medicines may also cause high cholesterol levels, diabetes, brittleness of bones (osteoporosis), and increase your risk of acquiring infections
- Heart rhythm problems, heart attack, or stroke
- Lung and kidney failure
- Severe coronary artery disease
These could lead to some further complications, such as:
- Infections due to reduced immunity
- Heart transplant rejection: the body does not recognise the transplanted heart and treats it like a foreign body
- Multi-organ failure may also occur as a complication following a heart transplant. It can be prevented if identified and treated at an early stage
What is heart transplant rejection?
In a normally functioning human body, the immune system protects the body by identifying cells that are foreign (not from our own body) and destroying them. Sometimes, after a transplant, your body’s immune cells identify the new organ as a foreign body and launch an attack against it. This is called transplant rejection. To prevent this, you will be given medicines that suppress your immune system, and you will need to take them for the rest of your life. Transplant rejection is a common phenomenon and can happen even to people who have been taking all their medicines regularly. Rejection results in the failure of the transplanted heart.
What are the causes of heart transplant rejection?
The exact causes of heart transplant rejection are unknown. You will be at increased risk of heart transplant rejection in the following conditions:
- Genetic mismatch between the donor and recipient hearts
- Young recipient
- Old donor
- Previous history of rejection
- Insulin resistance
- Coronary artery disease in a donor or recipient
- Cytomegalovirus infection
- High cholesterol levels
What are the symptoms of heart transplant rejection?
- Tiredness and fatigue
- Loss of consciousness and fainting
- Decreased urine output
- Fever and chills
- Flu-like body ache
- Swelling of the feet and ankles
- Sudden weight gain
- Irregular heartbeat
- Low blood pressure
How long can I live after a heart transplant?
It has been observed that patients who undergo heart transplants survive for around 25 years after the transplant. Advances that help transplant recipients to lead a long and fulfilling life include:
- Improved surgical instruments and devices
- More specific immunosuppression is needed to avoid transplant rejection
- Close monitoring to increase survival rates
- Improved medicines and assessment tools
