Heart transplant

Heart transplant is a complex operation where a severely diseased heart is removed and replaced with a healthy heart obtained from recently deceased donor. Heart transplant is usually carried out for end stage heart failure but it is a rare procedure due to the lack of available donors.

Indications

Heart transplant is the ultimate resort in the treatment of the following conditions:

  • Severe heart failure - where the patient is expected to die within a year and conventional treatment has failed.
  • Congenital heart disease - which would ultimately lead to heart failure and death if no conventional treatment is available or available options have failed.
  • Intractable angina or life threatening arrhythmias - very rare indication for heart transplant due to good availability and efficacy of conventional treatment.

Candidates for heart transplant are normally referred to tertiary heart centres for detailed investigation and assessment, including echocardiography and left and right cardiac catheterization, to exclude contraindications to the operation, e.g. kidney dysfunction which would be exacerbated by immunosuppressive medication needed following the transplant. Heart transplant is also not recommended in people with history of poor adherence to medication and hospital appointments due to the need for life long follow up after the surgery.

The operation

Patients on waiting list for heart transplant need to be contactable 24/7 and get to hospital immediately upon request to minimize the delay between the retrieval and transplant of the donated heart. During the heart transplant the patient is put on heart bypass machine, the diseased heart is removed and then new heart is connected to the main arteries and veins.

Follow up

All heart transplant patients need a life long care with frequent visits to hospital, regular tests and multiple medication. The actual operation is a major procedure but normally successful and with a dramatic improvement in the quality of life of patients who were previously extremely incapacitated.

The challenge is a long term care where a correct level of immunosuppression should achieve a balance between prevention of rejection of the heart and side effects including susceptibility to kidney problems, osteoporosis, infections and cancer. This however needs to be considered in the context of bleak prognosis of terminal heart failure without heart transplant.