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Heart Transplant

Alternate 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 offered only to people who, because of irreversible, chronic heart failure, are expected to die very soon otherwise.
Heart failure may be due to a variety of causes, such as:
  • coronary artery disease
  • damage to the heart muscles
  • congenital heart disease
  • valve disease
  • immune system rejection of a prior transplanted heart
Heart transplants have been successful in persons ranging in age from infancy 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, as are the following risk factors:
  • emphysema
  • poor leg circulation
  • smoking
  • 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:
  • cancer within the past 5 years
  • 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 medicines, such as prednisone, tacrolimus (i.e., FK506, Prograf) and cyclosporine (i.e., Gengraf, Neoral, Sandimmune), 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. There are now more than 4,000 people in the US waiting for a donor heart.
Waiting time may extend several years, if the person survives that long. 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 just 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 is given general anesthesia and 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 for recovery.

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