What is the heart transplant?As part of a heart transplant, the still active heart of a donor is implanted in a recipient.
As part of a heart transplant, the still active heart of a donor is implanted in a recipient. Heart transplantation is especially necessary in heart failure if the survival rate is less than one year. This is calculated using a score using the following parameters:
- the mean blood pressure
- the heart rate
- the maximum oxygen uptake
- the ejection fraction
- a coronary heart disease as a cause of heart failure
- if there is a block image in the ECG
- the pulmonary capillary occlusion pressure
Function, effect & goals
Chronic or acute heart failure is always treated with medications, which stabilizes patients. In some cases, however, stabilization does not succeed, making heart transplantation necessary.
A transplant is especially necessary if the heart muscle is irreversibly damaged, all treatment options have been exhausted and thus the life expectancy of the person affected is significantly reduced. In this case, patients will be put on a waiting list for transplantation after consultation with the cardiologist. The waiting time depends on the size, the weight or the blood type of the organ recipient. Until transplantation, the time may be bridged with an artificial heart, but this only supports the weak circulation of patients. However, in the longer term, an artificial heart can not be used, the maximum term is about three years.
Transplants are rejected if the recipient does not agree or is unable to assist in the necessary examinations or treatments. Another important criterion for organ allocation is the prospect of success based on the Transplantation Act. If all prerequisites for surgery have been met, the patient will also be reported to Eurotransplant, where all potential donor organ donors will be recorded. On average, patients wait for a transplant for several months, with very critical cases taking precedence.
Due to the unpredictable availability of a suitable donor organ, surgery can not be planned and is therefore always acute. Therefore, interventions can also take place at the weekend or at night. The organ recipient is immediately ordered to the hospital and the clinic organizes the organ removal or transport of the donor organ, which is often hundreds of miles away. Since an explanted heart can only survive outside of the body for a few hours, the communication must be perfectly coordinated. After the donor heart is removed, it is preserved in a four degree cold solution and transported to the recipient.
The explanting doctors also control the quality of the organ. If there are concerns about the function of the donor heart, the operation can be stopped without the recipient being harmed. In order to avoid long distances, you first look for a suitable recipient in the donor's environment. The heart is not harvested until the transplant is completed within the next four hours. If the donor heart arrives at the clinic, the removal of the diseased heart begins. The blood supply to the organs is taken over by the heart-lung machine during this time. The veins that lead into the systemic circulation or to the lungs, severed by the surgeon so that a part of the right or left atrium stops.
Then the donor heart is sewn to the tissue remnants. The new heart is connected to the bloodstream and can then resume pumping power. After the heart transplantation, an intensive therapy lasting approximately seven days is connected. The organ recipients are maximally immunosuppressed, so that a rejection of the organ can be prevented. The risk of infection is highest during this time, so patients need to be isolated. The repulsive crises are usually in stages.
If they occur about every two weeks in the first three months, stabilization will take place after some time. This is followed by rehabilitation on the normal ward, which lasts about three to four weeks. In addition, regular checks are necessary in the first year. The doctor removes tissue from the heart in order to be able to record the immunosuppression. Through the tissue samples, he can determine whether the organ is possibly repelled. In a moderate or severe rejection reaction, patients are treated with cortisone.
Risks, side effects & dangers
A heart transplant is an intervention that involves certain risks. Surgical technique is no longer difficult these days, but bleeding, thrombosis or wound healing disorders can occur in the first few weeks after surgery. Immunosuppressive drugs also weaken the immune system, increasing the risk of potential infection. Not all patients are suitable for transplantation, the risk rate is increased by the following circumstances:
- Diseases of the liver, lungs or kidneys
- Vascular diseases of the leg or neck arteries
- Drug or alcohol abuse
- Age of more than 60 years
- acute pulmonary embolism
- certain systemic diseases such as tissue degeneration
It is important that the patients themselves observe their body very closely in order to notice a possible change. Possible symptoms that indicate rejection are:
- Weight gain due to accumulation of water in the body
- shortness of breath
- temperature rise
- lower load capacity