 What you need to know
A donor enables a diseased heart to be replaced by a healthy one.
The first heart transplant procedure ever carried out dates back from 1967, by Pr. Barnard's team.
Cardiomyopathy represents 40 to 50% of all transplant needs. The rest comes from severe coronary diseases, and, less frequently, from congenital malformations.
Heart transplant is an expensive procedure which necessitates the intervention and synchronisation of several medical teams. This procedure is only carried out when the physician considers the disease to be in its final stage, and that treatments cannot be beneficial anymore.
For the intervention, one of the medical teams prepares the recipient while another takes the organ from the donor. Conservation time being very short (4 hours for the heart), important means can be mobilised such as police forces, trains and helicopters.
Heart transplant is a "simple" procedure techniquely-speaking and surgical complications are relatively rare, with less than 10% of all cases. The major risks come from infections and more often from the reject of the organ by the recipient. The use of medication to diminish the intensity of the reactions by the body can be risky. The monitoring of transplanted patients is very thorough. Many experience difficulties with secondary effects caused by the anti-reject treatment. The procedure itself lasts between 6 and 8 hours. The patient is then transfered to reanimation and stays there until the first myocardial biopsy (approximately 10 days).
The patient will be back home around 21 days after the procedure but will have to be monitored regularly and attend a day in hospital to undergo a series of tests such as biopsies, blood tests, consultation with a cardiologists, etc. Unfortunately, the number of recipients exceeds greatly the number of donors. In countries like France or the US, there are few donors for a particularly large amount of people in need of a transplant. To help people while they wait for a transplant, new medications are available to improve the overall state of the patient, particularly regarding people suffering from cardio-myopathy.
Ventricular assistance also helps the patient to recover a satisfying level of autonomy with a system of pump powered by batteries. This system delays the effect of the disease and allows the patient to wait a few months for a transplant.
During the operation, the patient is placed on a heart-lung machine. The patient's diseased heart is removed except for the back walls of the atria. The back walls of the atria on the donor's heart are opened and sewn onto the old heart atria walls. A similar process is followed in heart-lung transplants. The donor's heart and lungs are removed as a unit. The patient's diseased heart and lungs are removed; the new lungs are attached first, followed by the heart.
When the new organ(s) is in place, surgeons reconnect the blood vessels and allow blood to flow again through the heart and lungs. As the heart warms up, it begins to beat again. If it does not spontaneously resume beating, it is started by using an electrical shock. All the connections of blood vessels and heart chambers are checked for leaks. If no leaks have been found, the patient is disconnected from the heart-lung machine. Patients are usually up and around a few days after surgery, and if there are no signs of the body rejecting the organ(s), patients are allowed to go home within two weeks. |
