Heart Transplant

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Learning that you may need a heart transplant is never easy. Whether you have been sick for only a short period of time or a long time, you may still find it hard to believe that this is happening to you. You may feel at a complete loss, and a feeling of despondency may come over you at the thought of a long drawn out course of treatment that is a heart transplant.
But just remember that having a heart transplant can offer you a second chance at life and hope for the future. Sure, life will be different after your transplant. You will have to make a lifetime commitment to taking care of your new heart. This is not as frightening as it sounds. If you follow the instructions laid down for you by your doctors and take all your medications, there is every chance that you will make a complete recovery. Getting back to work, resuming your old activities, and being able to do many more activities with your new heart are things you can look forward to once the transplant is done.
In India, there have been over heart transplants done. Unfortunately most of these have been in the South of India which has a good organ donor network in place. North India is sadly lacking in this area. But the fact is that Chennai is a 2 hour plane ride away, and moving there to wait is sometimes the only option for potential heart recipients.

History of Heart Transplantation
Heart transplant surgery has become a well-recognized treatment for some people with heart failure. Three major factors have made heart transplants a success: advances in surgical techniques, the discovery of better anti­rejection medications, and increasing public awareness of the need for organ donors.
Research into heart transplant surgery began in the 1950s and1960s. The first heart transplant in human beings was done in South Africa in 1967 by Dr. Christian Barnard but sadly the patient only lived for 18 days. Since then, most of the research that led to successful heart transplantation took place in the United States at Stanford University under the leadership of Dr. Norman Shumway. Once Stanford started reporting better results, other centers started doing heart transplants. However, heart transplants were not a big success until medications were developed to prevent the recipient from “rejecting” the donor heart. This happened in 1983 when the Food and Drug Administration (FDA) approved a drug called cyclosporine. Suddenly, heart transplants became a reality.
Today’s scientific advances have changed heart transplantation from an experimental procedure to a trusted treatment for some patients with advanced heart disease. Over 60,000 heart transplants have been performed around the world. Of patients who receive a heart transplant, over 80% will survive the first year following surgery; around 70% will survive five years and50 % ten years.

How Your Heart Works
The heart is a hollow muscle about the size of a fist. Its job is to pump blood throughout your body. The heart has four chambers divided into left and right sides and works as a double pump. The left side pumps blood rich in oxygen to your muscles, skin and organs. As the blood is circulated to these body tissues, it delivers nutrients and oxygen, and removes waste products. The right side of the heart receives the blood that has come back from the body tissues, and pumps it to the lungs. In the lungs, the blood receives a fresh supply of oxygen. The blood is then returned to the left side of the heart where it is pumped throughout the body again. This cycle repeats itself 50 to 100 times a minute.

How Heart Failure Affects Your Health
A healthy heart pumps blood to all parts of your body in a matter of seconds. Heart failure occurs when the heart can no longer pump forcefully enough. The blood that should be pumped out of your heart backs up and collects in the lungs and other parts of your body. This is why you may experience shortness of breath and swelling in your hands, legs, and feet. Some people with heart failure have enlarged hearts, which can be seen on a chest x-ray. As a weak heart struggles to pump out all its blood, the muscle fibers of the heart stretch. Over time, this extra stretching leaves the heart with larger, weaker chambers.

What happens during a heart transplant procedure?
Believe it or not, heart transplantation is a relatively simple operation for a cardiac surgeon. In fact, the procedure actually consists of three operations.

The first operation is harvesting the heart from the donor. The donor is usually a person who has suffered irreversible brain injury, leading to “brain death”. Very often these are patients who have had major trauma to the head, for example, in an automobile accident. The victim’s organs, other than the brain, are working well with the help of medications and other “life support” that may include a respirator or other devices.

The second operation is removing the recipient’s damaged heart. Removing the damaged heart may be very easy or very difficult, depending on whether the recipient has had previous heart surgery (as is often the case). If there has been previous surgery, cutting through the scar tissue may prolong and complicate removal of the heart.

The third operation is probably the easiest; the implantation of the donor heart. Today, this operation basically involves the creation of only five lines of stitches, or “anastomoses”. These suture lines connect the large blood vessels entering and leaving the heart. Remarkably, if there are no complications, most patients who have had a heart transplant are home about one week after the surgery.

The generosity of donors and their families makes organ transplant possible.

Common Diseases That May Lead to Transplantation
Coronary Heart Disease
Coronary heart disease, also commonly called coronary artery disease, is a narrowing or blockage of the coronary arteries, the arteries that provide the heart muscle with blood. The disease occurs when these arteries become hardened and narrowed. The arteries harden and narrow due to build-up of a material called plaque on their inner walls. The build-up of plaque is known as atherosclerosis. As the plaque increases in size, the insides of the coronary arteries get narrower and less blood can flow through them. Eventually, blood flow to the heart muscle is reduced, and, because blood carries much-needed oxygen, the heart muscle is not able to receive the amount of oxygen it needs. Heart transplantation is performed to replace a failing heart that cannot be adequately treated by other means.

Congestive Heart Failure (CHF)
End-stage heart failure is a disease in which the heart muscle is failing severely in its attempt to pump blood through the body, and in which all other available treatments are no longer helping to improve the heart’s function. End-stage heart failure is the final stage of heart failure. Heart failure, also called congestive heart failure, or CHF, is a condition that occurs when the heart is unable to pump blood sufficiently. Despite its name, a diagnosis of heart failure does NOT mean the heart is about to stop beating. The term “failure” refers to the fact that the heart muscle is failing to pump blood in the normal manner because it has become weakened.

Cardiomayopathy
Unlike heart disease due to heart attacks, where there is a problem with adequate blood flow to the heart, cardiomyopathy is a disease of the heart muscle itself. There are many causes of cardiomyopathy, which may include coronary artery disease and heart valve disease. Cardiomyopathy occurs in three major types – dilated, hypertrophic and restrictive – all of which affect your heart’s ability to pump blood and deliver it to the rest of your body.

Related Links
Registering, The Stressful Wait, Preparation
The Transplant
Post Transplant Care
Rejection & Infections
Going Back Home – Do’s & Don’ts
Things You Need to Know Post Transplant
Lungs
Intestines
Pancreas

References:
Fortis Memorial Research Institute
www.medanta.org
http://www.bhf.org.uk/