Alternative Names cardiac transplant, transplantation of the heart
Definition A heart transplant is performed to treat heart failure due to disease or injury. A donor heart is removed from a person deemed brain dead. The heart is then transplanted into the recipient.
Who is a candidate for the procedure? A heart transplant is only offered to people who have irreversible, chronic heart failure. This may be due to a variety of causes, such as:
graft failure that requires another heart transplant
Heart transplants can be done with success from infancy on through the 60s. Potential candidates are evaluated by a multidisciplinary team. The team may include:
transplant surgeons
medical heart specialists called cardiologists
social workers
nurses
transplant coordinators
The team considers many factors. The person's general health and suitability for major surgery are taken into account. So are risk factors, such as:
liver or kidney problems and other conditions that may be treated before the transplant. Treatment of these problems improves the chance of success and reduces complications.
Only a few conditions would absolutely rule out a heart transplant. These include:
some infections that cannot be completely treated or cured, such as tuberculosis
severe lung, liver, or kidney problems that would make the operation too risky
The candidate must be willing to take anti-rejection medications, such as prednisone, tacrolimus and cyclosporin, indefinitely to keep the body from rejecting the new heart.
If a person is a suitable candidate, a donor must be found. The recipient's name is put on a waiting list. As at July 2000 there were 39 people in Australia waiting for a heart transplant. Waiting time was approximately 3 to 12 months.
People waiting for donor hearts are grouped by the severity of illness. Within any given group, hearts may be allocated based on the length of time a person has been on the waiting list.
How is the procedure performed? Two or three surgical teams may operate on the donor at the same time so that several organs can be removed. Even though the donor is brain dead, the procedure is done in a sterile operating room and is like any other surgery. The organs are removed, preserved, and packed for transport. After this, the donor's incisions are closed and normal preparations for a funeral or cremation take place.
The heart must be transplanted into the recipient within 4 to 5 hours. The recipient will receive general anaesthesia. He or she will be placed on the cardiopulmonary bypass machine. This machine oxygenates the blood while the heart transplant is being performed.
Once the transplant is done, the donor heart may need shocking to start beating again. Special drugs are given to establish a stable heart rate and blood pressure. A careful check is made for any bleeding and the heart is observed to see if it is pumping normally.
The recipient is then taken to the intensive care unit, or ICU, for recovery.
What happens right after the procedure? After a heart transplant, a person usually stays in the intensive care unit for 2 to 5 days. Often he or she will stay on an artificial breathing machine, or ventilator, overnight. On the second or third day, the person may be well enough to move out of the ICU. Generally, he or she can start eating again within 2 to 5 days.
Medications to prevent rejection of the new heart are begun at the time of surgery. A combination of 2 or 3 different medications is given. Rejection of the heart may occur without any early symptoms, so frequent biopsies are done. A small tube is passed through the jugular vein in the neck and into the heart. A tiny piece of heart muscle tissue is removed and is examined under a microscope for signs of tissue rejection.
Before leaving the hospital, the person will receive a lot of information from the transplant team. He or she will learn the importance of taking medications as prescribed. Signs of Rejection are stressed so that the person and family know what to watch for. A program of exercise and rehabilitation will also be prescribed.
What happens later at home? At home, the recipient can expect a slow, but steady recovery.
Walking is encouraged to prevent lung problems and restore strength.
Heavy lifting and straining should be avoided for 4 to 6 weeks.
Driving is permitted once the incision is painfree.
Sexual activity can be resumed when the person is comfortable.
Overall results of heart transplants are quite good. Depending on the level of the person's illness at the time of the transplant, a successful outcome can be expected in 85% to 90% of cases. About 70% of people who had transplants between 1987 and 1996 have survived at least 5 years afterward.
What are the potential complications after the procedure? Many complications are possible after a heart transplant.
Infection. An infection can be very serious for a heart transplant recipient. The medication he or she takes to prevent rejection suppresses the immune system. This raises the overall risk of infection. Fortunately, common postoperative infections, such as a urinary tract infection, is not usually serious. A serious infection, such as one that affects the sternal incision and bone, can be very hard to treat. It can cause death. Pneumonia after a heart transplant can also be very serious.
Vascular problems. Major bleeding after a transplant is not uncommon. Virtually all heart transplant recipients need a blood transfusion during the operation. About 5% of heart transplant patients need a second operation within 24 to 48 hours to correct bleeding. This is often a result of constant oozing from the raw operated surfaces or leakage from sutures or staples.
Rejection. The body's normal response to a transplanted organ is to reject it. The immunosuppressive medications that are prescribed prevent rejection in 50% to 75% of cases. People who do have rejection episodes can be diagnosed with an echocardiogram and analysis of a sample of tissue from the transplanted heart. Rejection is usually treated by increasing the amount of drugs taken or switching to different medications. Most of the time, it can be reversed. The more severe the rejection episode, the more likely there will be permanent scarring in the heart. That affects how long the organ will continue to work.
Cancer. Another long-term complication of immunosuppressive mediations is cancer. An estimated 6% to 8% of people who have had a transplant will develop cancer at a later date. This is a much higher rate than in the general population. The most common malignancy is skin cancer. Usually, it can be successfully treated.
Organ donation is only possible through the charitable deeds of individuals or next of kin who make suitable organs available. This process is facilitated when renewing your Driver's Licence or when completing an Advance Health Directive. It is an issue each person should consider.
Author: Robert Merion, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
