What Are The Advantages And Disadvantages Of This Procedure
The biggest advantage of heart transplantation is that its a life-saving option when other options didnt work, were too risky to use, or were unlikely to help.
The biggest disadvantages of heart transplant are:
- More people need a heart transplant than there are available donor hearts.
- Its an extremely complicated surgery, limiting it to only the most well-equipped and best-staffed hospitals.
- Some people may be too ill to survive the procedure.
- The procedure has several potential risks and complications .
What are the risks or complications of this procedure?
The most common risks and complications of heart transplant include the following:
- Organ rejection.
- Graft failure .
Why Is This Treatment Done/used
A heart transplant is a last-resort treatment when you have end-stage heart failure. That means your heart has permanent damage or weakness that keeps it from pumping enough blood to your body.
This kind of heart failure can happen for a wide variety of reasons, ranging from infections that damage your heart muscle to abnormal heart rhythms that may cause a reversible weakening of the heart.
Diagnoses most likely to result in heart transplant
The following conditions make up the majority of reasons for heart transplant:
- Cardiomyopathy. This refers to any disease that damages your heart muscle . Diseases that cause this kind of damage include infections, genetic diseases and damage from medical treatments .
- Coronary artery disease. This is a condition that affects the arteries that supply your heart. Its a common cause of heart attack.
- Congenital heart disease. This is any heart disease you have when youre born.
- Valvular heart disease. These are conditions that involve damage to your heart valves.
- Retransplants. These are instances where a person needs a second transplant to replace the first. This can happen because the donor’s body rejects the first transplanted heart or for other reasons.
What Happens During Heart Transplant Surgery
When you get to the hospital, the transplant team will prepare your child for surgery. They may run a few tests to be sure that the new heart is a good match. Then, your child goes to an operating room.
In the operating room, your child will get anesthesia to sleep through the operation. The surgeon makes an incision in the chest and removes the sick heart. The new heart is placed in the chest, and the surgeon connects it by sewing its blood vessels to the blood vessels in your childs body. So that doctors can check heart function, the incision might not be closed right away.
Most heart transplant surgeries last between 4 and 6 hours. Someone on the transplant team will keep you informed about how the surgery is going while you wait.
Remember these points to protect yourself from infection:
- Take care of cuts or wounds and wash hands thoroughly:
Keep minor cuts and wounds clean. Wash them with soap and water or hydrogen peroxide, dry your skin and cover the cut with a sterile bandage.
Go to the emergency room near your home if you have a deep cut, or one that bleeds a lot. Be sure to tell the health care providers that you are a transplant patient.
Frequently wash your hands with soap and warm water, especially before preparing food, and after using the bathroom or after touching soiled linens or clothes. Lather well, rubbing your hands back and forth together, to clean all surfaces, including the nail beds and webbing between your fingers.
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A Practice Called Donation After Cardiac Death May Increase The Number Of Heart Transplants
United Network for Organ Sharing , a private, non-profit organization under contract with the federal government to manage the organ transplant system in the U.S., allocates newly available hearts based on such priorities as medical urgency. Patients who are hospitalized or dependent on mechanical assist devices to help their heart function are at the top of the list.
About 3,500 people in the U.S. are waiting for a heart, and many will wait more than six months. But some will die before a heart becomes available to them. Thats why one of the greatest breakthroughs in heart transplantation may be the practice of accepting donor hearts that most other programs do not have the expertise to accept. This means that more sick patients who are eligible may be able to receive one. A limited number of programs in the U.S. are starting to do this. Yale Medicine is one of them.
I remember we said to ourselves as a team: We’re going to switch gears now. We can be more aggressive and take some risks,’ says Muhammad Anwer, MD, associate director of the Center for Advanced Heart Failure at Yale New Haven Hospital and a key cardiac surgeon for heart transplantation. Now all the data that’s coming in is showing that the outcomes may be just as good with the more aggressive approach.
During DBD heart transplant, the heart is still beating, allowing for a controlled procurement, says Christopher Maulion, MD, who is spearheading the DCD program at Yale Medicine.
Who Is Not A Good Candidate
There are some general contraindications to receiving a heart transplant, though these vary by location, transplant center, and even surgeon. What one transplant center may say is a contraindication to being listed for a transplant may not be an issue for a different center.
Some of these issues may only temporarily prevent transplantation. For example, a patient would not receive a transplant while they have a current high fever and an active infection, but would be eligible once they are well.
People who are not candidates for a heart transplant include those with:
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Evaluation Process For Heart Transplant
The transplant evaluation starts with a comprehensive review of your past medical history by a transplant cardiologist. You’ll meet with the transplant cardiologist to discuss the nature and prognosis of your cardiac disease and determine if any other traditional treatments would be beneficial prior to consideration of a cardiac transplant. Certain cardiac tests may need to be performed that are different from prior tests you may have had with your cardiologist.
The next step involves determining if your body is well enough to achieve a successful outcome from a cardiac transplant. This also involves a lot of testing and consultations. A team of specialists including physicians, nurses, social workers, behavioral health professionals and transplant coordinators will meet to review your case and determine your best course of care and potential for listing.
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How Can I Help My Child
Having a serious condition can be hard for kids. Surgery and immunosuppressant therapy can add to the stress. Talk to your child about these changes and how you will work them into your routine. Make sure to find time to do fun things together with family and friends.
For teens, immunosuppressant therapy can be a challenge. These medicines can cause:
These side effects are a major reason why teens are at risk for not taking their medicines after a transplant. This can be dangerous and even lead to rejection of the new heart. So be sure to talk about the importance of taking all medicines as directed.
Are There Requirements For Living Near The Transplant Center
One criterion for being on the transplant list is the ability to get to our facility within four hours. You can accomplish this by simply driving, arranging after-hours air flight capability or temporarily moving closer to the transplant hospital.
After the transplant, you must live within 50 miles of the transplant hospital for the first six to eight weeks. Baylor University Medical Center has a low-cost on-campus apartment, Twice Blessed House, where transplant patients and their families may live during this time.
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It Takes A Community To Support A Heart Transplant Patient
In some ways, when you get a transplant, you become part of the transplant family. We plan to be with our patients all their lives, says Dr. Ahmad.
In the hospital, this team includes cardiologists who work hand-in-glove with the cardiac surgeons, as well as other surgeons, anesthesiologists, transplant coordinators, electrophysiologists, infectious disease specialists, nephrologists, nurses, and social workers.
The team supports patients not just medically, but also mentally, psychologically, and spiritually, Dr. Jacoby says.
Since so much recovery happens at home, its helpful to seek care at a transplant center close to home. Patients benefit from being geographically close to family and friends, Dr. Sen says. The journey after transplant is often an amazing thing. Before the operation patients are very sick. Seven days after the surgery, they’re walking out of the hospital, and they feel completely different, he says. At that point, many patients are happy to have their loved ones around them for support as they get back to the business of living a normal and healthy life.
Failure Of The Donor Heart
Over time the new heart may fail due to the same reasons that caused the original heart to fail. Failure of the donor heart also can occur if the body rejects the donor heart or if blood vessel disease develops in the new heart and causes it to fail. This blood vessel disease is called cardiac allograft vasculopathy .
Patients who receive a heart transplant that fails can be considered for another transplant .
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Precautions To Take After Surgery
Once the heart transplant surgery is completed, there are several precautions that you need to keep in mind. These adjustments might seem overwhelming, but they ensure that you can recover fast and can lead a normal life after a heart transplant.
Your doctor will prescribe immunosuppressants which are used to ensure your immune system does not attack the new healthy donor heart after it has been transplanted. Immunosuppressants ensure the risk of heart rejection is decreased. These are usually prescribed lifelong. Even with the help of immunosuppressants, your immune system might still not fully accept the new heart. The problem with immunosuppressants is there are many side effects, especially in the beginning.
Immunosuppressants can make you prone to infections because your immune system is suppressed and is not working optimally. For this, your doctor will prescribe additional medication. Sometimes, immunosuppressants can worsen some health issues, such as diabetes and high blood pressure. It can increase the risk of developing other health problems, like high cholesterol, as well.
The key to recovery, after a heart transplant surgery, is to ensure you listen to what your doctor advises. You need to make lifestyle changes so that you dont develop any infections, in the future. You may need to include exercise and healthy eating habits in your routine.
Nhs Organ Donor Register
If you’re interested in donating your organs after you die, you can join the NHS Organ Donor Register.
Joining the NHS Organ Donor Register is quick and simple, and will only take a few minutes of your time.
You can remove yourself from the register at any time and can specify what you’re willing to donate.
Page last reviewed: 30 April 2019 Next review due: 30 April 2022
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How Long Will I Wait For A New Heart
After being approved for transplant, you will be put on the United Network of Organ Sharing list, which comprises all individuals who are waiting for an organ transplant in the country. How long you must wait for a heart depends on a number of factors, including blood type, immunologic match, body size, and length of time on the list.
It is critical that you work with the transplant team to identify ways to maintain a lifestyle that will provide optimal health before transplantation. Healthier, pre-transplant patients are more likely to have better post-operative experiences.
While you are waiting for a new heart, you may receive an insertable device. A mechanical circulatory support device will help improve your quality of life while monitoring heart problems.
Becoming Inactive On The Heart Transplant Waiting List
Surgeons must transplant a donor heart within a certain amount of time. You will always need to be within four hours of the hospital while you’re on the heart transplant waiting list.
Please inform your transplant coordinator of any travel that will take you outside the four-hour window.
If you must travel, we may place you in an inactive status,” or status 7,” on the list.
Other reasons for an inactive status include:
- Needing further tests.
- Having certain health problems that might increase your risk of transplant surgery.
- Not following the treatment plan from your heart transplant team.
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How Do I Know If I Need A Transplant
Some patients with severe heart disease may benefit from transplantation. Your cardiologist or pulmonary medicine specialist may refer you to a transplant center for an evaluation. The purpose of the evaluation is two-fold:
- To determine the severity of your disease and whether there are any more conventional treatments
- To determine whether you would be able to survive the transplant operation and have a good long-term result afterwards
Heterotopic Heart Transplantation: The Clinical Programme
Forty-nine consecutive heterotopic heart transplants were performed in Cape Town between 1974 and 1983, with moderately good results for that era.7 Three of the first five patients survived more than 10 years. During this time it became clear that if irreversible rejection and failure of the donor heart developed, excision and replacement of the donor heart was not only technically difficult, but associated with significant morbidity. At the re-transplant operation, it was preferable to replace the patients native heart by performing an orthotopic transplant, leaving the original heterotopic transplant in situ, even if it were no longer functioning. This prevented the necessity of dissecting the donor heart from the right lung, to which it might be tightly adherent.
Two 14-year-old boys, both of whom initially received heterotopic transplants, underwent a second heart transplant for graft atherosclerosis, and were therefore the first patients in the world to have two donor hearts in their chest at the same time. The first of these remains well, 29 and 26 years after the hetero- and orthotopic transplants, respectively. In the other, the second transplant also eventually failed and he underwent a third transplant, again in the orthotopic site, and thus became one of the few humans to have had four hearts in his lifetime.
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Watching For Signs Of Rejection
The new heart is a “foreign body,” which your immune system may attack if you’re not receiving enough medicine to suppress your immune system after the surgery. Therefore, you and the transplant team will work together to protect the new heart by watching for signs of rejection. These signs include:
- Shortness of breath
- Reduced amounts of urine
You and the team also will work together to manage the transplant medicines and their side effects, prevent infections and continue treatment of ongoing medical conditions.
You may be asked to monitor your temperature, blood pressure and pulse when you go home.
How Long Can You Live After A Heart Transplant Survival Rates
With advancements in medicine and technology, heart transplant survival rates have improved dramatically over the past few decades. According to recent studies, the average life expectancy of a heart transplant patient is 9.16 years.
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When Your New Heart Becomes Available
When we find a good match and assign you a donor heart, your transplant coordinator will call you right away. He or she will let you know what happens next.
While you travel to the hospital, the UPMC heart transplant team continues to assess the donor heart.
If the team finds the heart:
- Is right for you, we’ll begin to prepare you for heart transplant surgery once you arrive.
- Is not a good match, we’ll send you home and keep you on the waitlist.
Risks Of A Heart Transplant
A heart transplant is a complex and risky procedure.
Possible complications include:
- the immune system recognising the transplanted heart as foreign and attacking it
- the donated heart failing to work properly
- narrowing of the arteries supplying the heart
- side effects from the immunosuppressant medication, such as an increased vulnerability to infections, weight gain and kidney problems
Many of these problems are treatable, although sometimes another heart transplant may need to be carried out if possible.
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Potential Complications Of A Heart Transplant
There are several potential risks of complications that may follow surgery. The most common complications include:
- Active infection