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:
coronary artery disease
damage to the heart muscles
congenital heart disease
valve disease
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:
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 and cyclosporine, 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.
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 anesthesia. 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 IC, for recovery.
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