Heart transplant

A heart transplant or a cardiac transplant, is a surgical transplant procedure that is performed to replace a diseased, failing heart is with a healthier donor heart.

Some facts about Heart transplant:

• Heart transplant is performed on patients with severe coronary artery disease or end-stage heart failure when the condition does not improve with other medical or surgical treatments.
• Although a heart transplant is a major operation, the chance of survival is good with appropriate follow-up care.
• The most common procedure of a heart transplant is to take a functioning heart, with or without both lungs, from a recently deceased organ donor and implant it into the patient.
• The heart of the patient is removed and replaced with the donor heart in orthotopic procedure and the diseased heart of the recipient is left in place to support the donor heart in heterotopic, or 'piggyback', transplant procedure.
• A heart transplants is required when other treatments for heart problems have not worked, leading to heart failure.
• The cause of heart failure can be a weakening of the heart muscle or cardiomyopathy, coronary artery disease, heart valve disease, congenital heart defect, ventricular arrhythmias and failure of a previous heart transplant.
• A heart transplant is not recommended for individuals if the person is at an advanced age where the ability to recover from transplant surgery becomes difficult, have an active infection or ave a recent personal medical history of cancer.
• A heart transplant is also not recommended for individuals if the person have another medical condition that could shorten your life, regardless of receiving a donor heart, such as a serious kidney, liver or lung disease
• A ventricular assist device (VAD) is an alternative to heart transplant or some people who cannot have a heart transplant. It is a mechanical pump implanted in the chest of a person who have heart failure but are not eligible for heart transplants as long-term treatments.
• VADs are commonly used as temporary treatments for people waiting for heart transplants as it helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body.

Preparation of Heart Transplant:

• The preparations for a heart transplant begin weeks or months before you receive a donor heart.
• You should evaluate a heart transplant center and check your health insurance to see which transplant centers are covered under your plan.
• Consider the number of heart transplants a center performs each year and the survival rates while  evaluating a heart transplant center.
• You will need to have an evaluation to see if you are eligible for a transplant once a center is decided. The evaluation include having a heart condition that would benefit from transplantation, are healthy enough to undergo surgery and post-transplant treatments, might benefit from other, less aggressive treatment options, are willing and able to follow the medical program outlined by the transplant team and will agree to quit smoking, if you smoke.
• The center will put you on a waiting list if the transplant center medical team determines that you are a good candidate for a heart transplant.
• Your heart and other organs will be monitored and your treatment will be adjusted as necessary by your medical team while you are on the waiting list.
• A ventricular assist devices (VADs) will be recommended by your doctor to support your heart while you wait for a donor organ if medical therapy fails to support your vital organs.
• A pager or cellphone is provided by the transplant center to notify you when a potential heart is available. Your cellphone or pager should be charged and turned on at all times.
• You will have to go to the transplant hospital immediately after being notified as you and your transplant team have limited time to accept the donation.
• A final evaluation will be done by your doctors and transplant team once you arrive at the hospital to determine if the donor heart is suitable for you and if you are ready for surgery.
• You might not be able to have the transplant if your doctors and transplant team decide that either the donor heart or surgery is not appropriate for you.

Procedure for Heart Transplant:

• Heart transplant is an open-heart procedure that may take several hours. The surgery is more complicated and will be longer if you have had previous heart surgeries.
• General anesthetic will be received by you before the procedure.
• You will be connected to a heart-lung bypass machine by the surgeon to keep oxygen-rich blood flowing throughout your body.
• An incision will be made in your chest by the surgeon. Your chest bone will be separated and your rib cage will be opened by the surgeon so that he or she can operate on your heart.
• The diseased heart will be removed and the donor heart will be sewed into place. The major blood vessels will then be attached to the donor heart.
• The new heart will start beating when blood flow is restored. Sometimes an electric shock is required to make the donor heart beat properly.
• Medication will be provided to help with pain control after the surgery.
• You will be on ventilator to help you breathe and tubes in your chest to drain fluids from around your lungs and heart.
• You will also receive fluids and medications through intravenous (IV) tubes after surgery.

Recovery from Heart Transplant:

• Initially you will have to stay in the intensive care unit (ICU) for a few days, then will be moved to a regular hospital room.
• The patient will probably stay in the hospital for about a week or two after leaving ICU. The duration of stay in the ICU and in the hospital varies from person to person.
• You will be monitored at your outpatient transplant center by your transplant team after you leave the hospital.
• You will also be monitored for any signs or symptoms of rejection, such as shortness of breath, fatigue, fever, not urinating as much or weight gain.
• If you notice any signs or symptoms of rejection or infection, let your transplant team know.
• You will have frequent heart biopsies in the first few months after heart transplantation to determine whether your body is rejecting the new heart, when rejection is most likely to occur.
• The frequency of biopsies decreases over time.