As Heart transplant is an organ transplant from a donor to a recipient.
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 a year. This is calculated with the help of a score using the following parameters:
- the mean blood pressure
- the heart rate
- the maximum oxygen uptake
- the ejection fraction
- coronary heart disease as the cause of heart failure
- if there is a block image in the ECG
- the pulmonary capillary closure pressure
Function, effect & goals
Chronic or acute cardiac insufficiency is always treated first with medication, which can stabilize the patient. In some cases, however, stabilization does not succeed, so that a heart transplant is necessary.
A transplant is particularly necessary if the heart muscle is irreversibly damaged, all treatment options have been exhausted and the life expectancy of the person affected is significantly reduced. In this case, patients are placed on a waiting list for transplantation after consultation with the cardiologist. The waiting time depends on the size, weight and blood group of the recipient. Until the transplant, the time can possibly be bridged with an artificial heart, but this only supports the weak circulation of the patient. However, an artificial heart cannot be used in the long term; the maximum duration is around three years.
Transplants will be refused if the recipient is unwilling or unable to participate in the necessary examinations or treatments. Another important criterion for organ allocation is the prospect of success on the basis of the Transplantation Act. If all the prerequisites for an operation are met, the patient is reported to Eurotransplant, where all potential recipients of donor organs are recorded. On average, patients wait several months for a transplant, with very critical cases having priority.
Due to the unpredictable availability of a suitable donor organ, an operation cannot be planned and is therefore always acute. Therefore, interventions can also take place on the weekend or at night. The organ recipient is immediately ordered to the hospital and the clinic organizes the organ removal or the transport of the donor organ, which is often hundreds of kilometers away. Since an explanted heart can only survive outside the body for a few hours, communication must be perfectly coordinated. After the donor heart has been removed, it is preserved in a four-degree cold solution and transported to the recipient.
The explanting doctors also check the quality of the organ. If there are concerns about the function of the donor heart, the operation can still be stopped without harming the recipient. In order to avoid long distances, one first looks for a suitable recipient in the vicinity of the donor. The heart will not be removed until the transplant can take place within the next four hours. When the donor heart arrives at the clinic, the removal of the diseased heart begins. During this time, the blood supply to the organs is taken over by the heart-lung machine. The surgeon cuts the veins that lead into the body's circulation or to the lungs so that part of the right or left atrium remains.
Then the donor heart is sewn to the tissue remnants. The new heart is connected to the bloodstream and can then resume pumping. After the heart transplant, intensive therapy is followed, which lasts approximately seven days. The organ recipients are maximally immunosuppressed so that rejection of the organ can be prevented. The risk of infection is highest during this time, so patients must be isolated. The repulsion crises usually take place in stages.
If they occur about every two weeks in the first three months, they stabilize after a while. This is followed by rehabilitation in the normal ward, which takes about three to four weeks. Regular checks are also necessary in the first year. The doctor takes tissue from the heart in order to record the immunosuppression. Using the tissue samples, he can determine whether the organ is possibly being rejected. If the rejection reaction is moderate or severe, patients are treated with cortisone.
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Risks, side effects & dangers
A heart transplant is a procedure that involves certain risks. The surgical technique is no longer difficult nowadays, but bleeding, thrombosis or wound healing disorders can occur in the first few weeks after the operation. The immunosuppressive drugs also weaken the immune system, which increases the risk of possible infections. In addition, not all patients are suitable for a transplant, the risk rate is increased by the following circumstances:
- Liver, lung or kidney disease
- Vascular diseases of the leg or neck arteries
- Drug or alcohol abuse
- Age more than 60 years
- acute pulmonary embolism
- certain systemic diseases such as tissue degeneration
It is important that the patients themselves observe their bodies very closely in order to notice any change. Possible symptoms that indicate rejection include:
- Weight gain from water retention in the body
- shortness of breath
- Temperature rise
- Cardiac arrhythmias
- lower resilience