Heart Transplant

What is a heart transplant?

A heart transplant is a major operation that is performed to replace a diseased heart with a healthy one.

Given the scarcity of a donor’s heart, most patients with a heart transplant are put on a waiting list until a suitable donor is found.

As you wait for a suitable donor, you will go through a rigorous assessment by the transplant team.

The assessment will determine whether they can withstand the transplant process.

Who is likely to undergo a heart transplant? 

The following conditions can make you a candidate for a heart transplant:  

Heart failure

Patients with end-stage heart failure would benefit from a heart transplant. Your doctor must first establish that other forms of treatment may not work for you. 

A heart transplant is the only alternative available to you. In end-stage heart failure, the heart muscle experiences severe failure.  

The heart loses its ability to pump blood to the other parts of the body. 

Heart failure can be due to myocardial infarction (MI), high blood pressure, or viral infection.  

Congenital heart disease

This is a condition where one is born with an abnormally functioning heart.  

With advancements in medicine, the survival rate for people with congenital heart disease has improved significantly.  

Dilated cardiomyopathy

This is a heart disease that is characterized by a weakened and enlarged left ventricle, meaning it is poor at pumping blood.  

Valvular heart disease

Cardiovascular disease affects one or more of the heart valves, affecting their functionality.   

Hypertrophic cardiomyopathy

A genetic condition that affects the left ventricle of the heart, making it stiff and thick. This affects the heart’s ability to pump out or take in sufficient blood per heartbeat.   

Restrictive myopathy

A heart disease characterized by stiffening of the heart chambers, over time. Such stiffening affects the heart’s ability to relax normally between beats.  

What are the different types of heart transplants?

There are two types of heart transplants performed under general anaesthesia:

Orthotopic heart transplantation: This is by far the most popular heart implantation procedure. The transplantation team excises the recipient’s heart save for the left atria and right atria cuffs.

The transplantation team makes sure they have dissected the donor’s heart. Once the donor’s heart has been removed, it needs to be transplanted within four to six hours. The heart recipient undergoes general anaesthesia in readiness for the transplant.

The recipient’s heart is placed in a bypass machine to permit blood oxygenation even as the heart transplant goes on. The transplant team prepares the donor heart in readiness for implantation.

Heterotopic approach: This is a rare surgical procedure. The transplant team ensures the recipient’s heart remains in situ while the donor’s heart gets connected to the patient’s thoracic cavity.

One of the benefits of a heterotopic approach compared to an orthotopic approach is that the new heart functions as an assist device in the event of complications.

Liaise with your physician to find out if a heterotopic approach is best suited for your healthcare needs.

Who may not benefit from a heart transplant?

Some people may not be suitable candidates for a heart transplant. Your healthcare team will need to undertake a rigorous assessment to determine if your body can handle the strain of such a major surgery and whether the risks involved outweigh any benefits.

If you have the following conditions, you would be unsuitable for a heart transplant:

• Infection – It may be necessary to treat an active infection before being considered for a heart transplant

• Cancer – If you have been diagnosed with cancer and are being treated, it is important to ensure cancer remission before considering a heart transplant

• Obesity – If you are obese, you might consider losing weight in readiness for a transplant

• Organ damage – People who have suffered irreversible organ damage such as to the kidneys are not suitable candidates for a transplant

• Age – Persons aged 65 and above are less likely to undergo a heart transplant not because of their age but primarily due to having other health conditions that could bring about complications after a transplant

Preparing for a heart transplant

Candidates for a heart transplant must first undergo an evaluation by a healthcare team that includes your physician, a heart specialist, and a heart transplant team.

You will undergo a battery of tests to ascertain that a heart transplant is the most suitable treatment for your heart condition.

This evaluation helps to rule out other heart conditions that could hinder you from realizing the best health outcome.

Make sure you have actively engaged the evaluation team with any queries or fears that you might have regarding the heart transplant.

You would need to get admitted at a healthcare facility for between three and five days, during the evaluation phase.

The healthcare team will closely monitor your overall health and possibly adjust any medication you may be taking.

Being hospitalized allows the healthcare team ample time to conduct the tests needed and to monitor your general health.

The evaluation is conducted at a heart transplant center where specialists assess your heart condition.

Heart specialists will explore alternative treatments available to you. You will also be assessed to determine if you can withstand surgery.

Some of the donor-determining factors with a heart transplant include blood type and level of sickness.

Below are some of the tests that you would likely undergo during the evaluation process:

• Echocardiogram – This test relies on sound waves to develop images of your heart. An echocardiogram gives more detailed information and a picture of the heart compared to an X-ray image.
• Cardiac catheterization – This test involves inserting a catheter into the left or right side of your heart via the arm or groin. The test helps to examine your arteries and measure oxygen and blood flow.
• Electrocardiogram (EKG) – An EKG or electrocardiogram test assists with measuring and recording your heart’s electrical activity.

The following tests are necessary to determine the level of your immune system:

• Thyroid function

• Blood type

• Antigen/antibody reactions

• Kidney and liver test – This test encompasses lipid profile, liver function, kidney function, and complete blood count.

• Ultrasound – To check the current status of your kidneys

• Nutritional status  You will undergo a body protein assessment, calorie count, and diet assessment.

• Social-psychological assessment – Organ transplant often encompasses social-psychological issues such as financial issues, anxiety, stress, and family support.

These social-psychological issues greatly affect the patient’s ability to cope with the procedure and their recovery.

During the procedure 

Heart transplant surgery takes place under general anaesthesia. This is an open-heart procedure that takes a few hours baring any previous surgeries or the presence of a ventricular assist device (VAD). 

The general anaesthetic is administered before surgery. A heart-lung bypass machine is connected to the patient. 

The heart-lung bypass machine ensures a constant flow of oxygenated blood throughout the body. 

The bypass machine allows your surgeon to redirect blood around the heart. It also ensures your brain and body receive sufficient oxygenated blood throughout the procedure. 

Your surgeon makes a 7-inch incision to cut open your chest, effectively separating the rib cage from the chest bone. 

The surgeon removes your diseased heart and replaces it with the donor’s heart by stitching it in place.

The surgeon ensures that major blood vessels get attached to the donor’s heart. Once blow flow has been restored, the donor’s heart develops a rhythm of its own. 

In case of an improper heartbeat, an electric shock may be needed. Your surgeon will prescribe medication to manage pain following surgery. 

A ventilator assists you in breathing properly while the fluid accumulating in your heart and lungs gets drained using tubes.

Intravenous (IV) tubes act as the main means for administering medication and fluids following surgery. 

Patients who have undergone a heart transplant will need to spend a few days in the ICU during which time the surgical team monitors their recovery. 

If there are no complications, the patient continues recuperating in the general ward for the next 1-2 weeks. 

This time can vary from one patient to another, depending on such factors as age and overall health. 

You will need close monitoring by your transplant team even after being discharged from the hospital. 

The monitoring can be very intense and frequent and as such, it is advisable that you remain close to the healthcare facility for at least 90 days following surgery.

Effectiveness of a heart transplant  

A heart transplant is a major operation meaning that there can be life-threatening complications. 

One may hope to live for up to 15 years after a heart transplant. However, the lifespan is dependent on other individual traits of a patient, such as his/her general health and age.  

Duration of surgery  

A routine heart transplant can be administered in under four hours. The procedure may also take longer depending on the complexity of the surgery. 

If a patient has undergone another open heart surgery, the next transplant could take anywhere between 6 and 12 hours.

Alternatives for a heart transplant   

Not every patient is a candidate for a heart transplant. Thanks to advances in medicine, we now have new therapies that not only improve your heart function but also prolong life for such patients.

Below are several alternatives for a heart transplant:

Ventricular assist devices (VADs)

VADs are mechanical pumps inserted into your heart during the procedure to assist the heart with blood supply.

VADs are in themselves a definitive therapy for heart failure.  They have proven useful as life-extension medical devices for patients on the waitlist for a heart transplant.

The battery-powered device pumps blood from your left ventricle often extensively weakened due to heart failure, to the other parts of the body.

One of the drawbacks of a VAD device is the need for a constant power supply. With advances in technology, however, we now have portable VADs.

Cell transplantation therapy

Research findings from several clinical trials have demonstrated the effectiveness and safety of stem cell therapy as an alternative treatment to a heart transplant.

Stem cells have the potential for cardiac tissue regeneration, aiding in the repair of the heart muscle.

Stem cell therapy therefore holds a lot of promise as an alternative to conventional treatment for heart diseases.

Is a heart transplant reversible?  

A heart transplant is an irreversible procedure and if done correctly, it can restore your life.

Risks or complications associated with a heart transplant 

The main risks associated with a heart transplant include:

Rejection

Considering the new heart is a foreign tissue, your immune system might attack and reject this organ. This typically happens in the days and weeks following the transplant.

Some people may also take several months or years before rejection takes place. Here are the symptoms to look out for in case of rejection:

• Shortness of breath

• Abdominal pain

• Ankles appear swollen

• Heart palpitations

• Fever

• Tiredness

Immunosuppressant medication can help with avoiding rejection.

Infections

People who have undergone a heart transplant generally have a compromised immune system. Immunosuppressant medication may weaken your immune system, paving the way for infections.

Make sure you receive the vaccination that you might require. If you develop headaches, fever, or aching muscles, report this to your transplant team as soon as possible as this could be a sign of infection.

Ensure you do not come into contact with a person with an infection.

Primary graft dysfunction

The donated heart might fail due to primary graft dysfunction. The transplant team should be in a position to identify signs of primary graft dysfunction and suggest suitable treatment. This includes mechanical circulatory support of the new heart or medication.

Narrowed arteries

In case blood vessels connected to your donor’s heart have handed or narrowed, this may trigger a complication known as cardiac allograft vasculopathy (CAV).

Your surgeon will likely recommend medication to control CAV. Alternatively, it may be necessary to undergo a second heart procedure.

Recovering from a heart transplant 

Your recovery after a heart transplant continues at home after getting discharged from the hospital. It may take six to eight weeks before your incision heals.

You are likely to experience chest discomfort tightness and itching in the region around your incisions. The guidelines below will promote proper healing:

• To clean your incisions, use soap and water only

• Avoid using a washcloth to rub the incision

• Avoid any lotions or ointment on the incision

• Avoid driving for the first several weeks after surgery until your surgeon gives you the go-ahead

• Avoid lifting heavy objectives or engaging in strenuous activities in the weeks following surgery

• Work closely with your occupational and physical therapists to identify the safest activities to increase your stamina and strength

• Aim for a diet low in fat and salt

Look out for any signs of infection on the incisions. In case of any of these signs, contact your doctor immediately:

• If the incision has a redness around it

• If the incision is oozing or has increased drainage

• In case the incision line feels warm

• Fever

Ensure you take your immunosuppressive drugs and all other medication as prescribed.

Cost of a heart transplant in India 

The cost of a heart transplant in India ranges between Rs. 6,65,000 and Rs. 16,50,000. Several factors account for the wide discrepancy in cost include:

• Surgeon’s fee

• Admission room of choice

• Whether the patient experienced any complications after surgery

• The patient’s medical condition

• The kind of examination and lab tests that a patient has undergone

• Whether the surgery takes place in a private or public hospital

• Age of the patient 

Even after having factored in all these costs, it is still very cost-effective to have your heart transplant surgery in India, as opposed to Europe or the United States.

The average cost of a heart transplant in the United States is USD 1,664,800 while the same surgery in India costs around USD 40,000.

This cost also includes travel expenses, meals, and accommodation. Most healthcare facilities that conduct heart transplants in India have liaised with travel agencies to ease your travel arrangements.

Your healthcare provider may assist with the processing of travel documents in addition to arranging for accommodation in hotels near the hospital where you will undergo surgery.

Factors to consider in choosing the best healthcare facility in India for your heart transplant 

In choosing the best hospital in India for your heart transplants, have the following factors in mind while making such a decision:

• Look for a hospital that has received accreditation and quality certificates

• Consider a hospital that offers transport to and from your place of residence

• Check the qualifications and level of experience of surgeons and other members of the transplant team

• Consider a hospital with advanced equipment for diagnosis and therapy

• Check whether your hospital of choice offers assistance to international patients

References

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