Life before, during and after heart transplant

A heart transplant is a surgical procedure where the diseased heart is replaced by a healthy heart taken from the cadaver. Heart transplant is undertaken as the last course, only after all other treatments/ medications fail. Heart failure is the major factor that leads to heart transplant. Heart failure may occur due to, coronary artery disease, weakening of the heart muscle (cardiomyopathy), valvular heart disease, heart problem you’re born with (congenital heart defect), and failure of a previous heart transplant.

Pre-conditions of Heart Transplant

There are certain pre-conditions that need to be fulfilled before the heart transplant procedure. Heart transplant is not advised for people who are older than 65, those who have blockages in the arteries of arms or legs, has a personal medical history of cancer, and those unwilling to change their lifestyle (continuing with drinking and smoking).

Ventricular Assist Device

Ventricular assist device (VAD) is implanted in the chest to facilitate pumping of blood through the body. Patients who are waiting for heart transplant can avail the VAD facility only as a temporary measure. However, VAD is increasingly being used as a permanent treatment for heart failure.

Risks & complications of Heart Transplant

Heart transplant is prone to risks and complications. The primary risk is the body’s rejection of the transplanted (new) heart. The immune system of the body considers the transplanted heart as a foreign body, and makes every effort to reject it. To suppress the body’s immune system, the patient is given immunosuppressants, which are the medications that help to reduce the activity of the immune system.

The immune systems efforts to reject the new heart may not be visibly seen. The patient needs to take all the medications on time, and any negligence or forgetfulness on the part of the patient in taking medications may prove to be very serious and fatal.

Frequent biopsies of the newly implanted heart help to know its condition and state of health. In case of any symptoms like, shortness of breath, fever, weight gain, no urination and fatigue, it may signal that the body is rejecting the heart. Other complications in the post-heart transplant stage include problems with arteries, medication side effects, cancer and infections.

Preparing for the Heart Transplant

Preparing for the heart transplant is a long process, usually taking weeks or even months. A lot depends on the evaluation process, which studies the condition of the heart, life-style and habits viz. drinking and smoking, medications, disease history and others.

Each patient for heart transplant is kept on the waiting list. A team of doctors will monitor the heart and other organs. If the patients are prone for severe infection or stroke, they are removed from the waiting list. Only after complete recovery from the disease or condition, the patients are eligible for heart transplant. Patients with a set of conditions like medical urgency, blood type (A, B, AB or O), antibodies, compatible donor organ, and time spent on the waiting list are given preference in heart transplant.

Cleanliness and hygiene

Before the heart transplant, the doctor ensures that the patient is free of any diseases or infections. For example, a visit to the dentist may be advised to make sure that the infections of the mouth do not spread to the new heart, in the post heart transplant phase. Personal hygiene should be maintained, which includes regular brushing and bathing, proper grooming and dressing. This is mandatory for both, patients staying in the hospital, as well as patients living at home.

Measures taken just before Transplant

The transplant center calls the patient, once the compatible donor heart is available. The patiet is tested to ensure that there are no new medical problems. The ambulance is kept on wait to transport the patient from home to the transplant center. The patient has to undergo a few tests, before being readied for the transplant procedure.

Must Crucial Phase

Crucial is the process where a team of specialists examine the donor‰’s heart for its healthy condition, and compatibility with the recipient’s body. As the donor’s heart can be stored for up to 6 hours, the transplant procedure should be done within the limited time. Also, the recipient’s diseased heart is not removed until the donor’s heart is available in the heart transplant center. The transplant team, that includes heart surgeons, anesthetists, and support staff have to work for three to five hours, with no break to complete the heart transplant procedure.

Post Heart Transplantation phase

After the heart transplant, the patient is moved to the ICU, and kept on the ventilator machine till the body’s condition is normalized. The patient is moved to the high dependency or ‘step down’ ward where other cardiac and thoracic patients are also nursed. The high dependency or ‘step down’ area is ensured to be totally infection free. Visitors of the patients have to wear gloves, masks and gowns before they enter this restricted area.

Treatment offered to post heart surgery patients includes, use of immunosuppressant drugs which help to control the organ rejection by reducing the body’s immune system. The first dose of immunosuppressants is given before the heart transplant surgery. Antibiotics are given to fight all threats of infections, which are very high during the point of time immediately following the transplant procedure.

Complications: Dependence on steroids in the post heart transplant period may lead to weight gain. This can be tackled by regular exercise under the supervision of a trainer only. Patients may experience mood swings due to high doses of steroids in the early days after a transplant. The doctors keep a check on the new heart’s functioning through biopsy, and echocardiogram.

As the patient progresses with life, there may be need for lesser immunosuppressants. The fallout of immunosuppressants is seen as skin cancer and lymph gland tumors. This is due to body’s inability to fight infections in a reduced immunity condition. Immunosuppressants are steroids, and their fall-out is also evident as damage to the kidneys and thinning of the bones.

Life after a Heart Transplant

Heart transplant patients are discharged from the hospitals or heart care center within two to three weeks after the operation. However, the patients need to visit the consulting doctor for observation and follow-up on complications. The patients can avail weekly appointments at the outpatient clinic of the heart transplant center. Over time, the patients can visit the doctor two or three times in a year.

The rate of recovery of heart transplant patients depends on their general health condition. Those who are weak, and have infections may take more time for complete recovery. Rehabilitation programs for heart transplant patients include gymnasium, physiotherapy and advice on healthier lifestyle. However, the quality of life is good if the side effects of immunosuppressants are kept to the minimum. Normal life activities viz. regular human activities (eating, sleeping, walking, working etc)