What Is Heart Transplant?

Introduction

A heart transplant is when a damaged or failing heart is replaced by a healthy human heart from a donor. A heart transplant is a procedure done when medications are not working for a failing heart.¹

The first successful human heart transplant was done in 1976 in Cape Town, South Africa by a surgeon called Christian Barnard. UK’s first long-term successful heart transplant was done on August 18^th 1979 by Sir Terence English, who was one of the founders of the British Heart Foundation along with other great heart surgeons like Magdi Yacoub.²

Why heart transplants are carried out?

Heart transplants are done when the patient has a severe heart failure and medications are not helping anymore. 

There are certain heart conditions where patients eventually need a heart transplant.^3,4

• Arrhythmia is a condition where there is an irregular heartbeat.
• Coronary heart disease is when there is a build-up of fatty substances in the wall of arteries supplying the heart, leading to a block of blood flow to the heart.
• Cardiomyopathy is the  weakening of the muscles of the heart.
• Congenital heart disease is a birth defect that affects the normal function of the heart.
• Heart attack (Myocardial infarction or MI).
• Viral infection of the heart muscle.

Heart failure can negatively impact the quality of life of patients suffering from it, patients experience various symptoms that affect their life such as fatigue, sleeping difficulties, oedema, chest pain, and depression. These symptoms affect the emotional and physical abilities of the patients leading to poor quality of life, and that is associated with high hospitalisation and mortality rates^.4

Who is not a good recipient of a heart transplant?

You might not be eligible for a heart transplant if you:

• Are at an advanced age and you can not tolerate a major surgery.
• Have an active infection.
• Have a recent history of cancer.
• Have any medical conditions that could shorten your life expectancy.
• Unwilling to make life modifications to ensure the success of the heart transplant.

An alternative for patients who are not a good candidate or patients who are on a long waiting list is implantable left ventricular devices (VADs or LVADs). This mechanical pump helps pump blood from the ventricle to the rest of the body. VADs can be used as a temporary solution while patients wait for their heart transplant surgery, or they can be used as a permanent treatment.⁵

The process of heart transplant in the United Kingdom

The process of the heart transplant is very complex and sensitive, the patient needs to be assessed by a specialist and then referred to a transplant centre to confirm their eligibility for a heart transplant. After confirming the patient's eligibility, they will be put on the transplant waiting list.

Here we will briefly mention the process of waiting for a heart transplant, starting with the process of organ donation and how you can get registered to be an organ donor.

The NHS Donor Register refers to the organ donor register maintained by the National Health Service (NHS) in the United Kingdom. This register is a database of individuals who have voluntarily chosen to donate their organs and/or tissues for transplantation after their death. People can register as organ donors through the NHS Organ Donor Register, indicating their willingness to donate organs such as the heart, liver, kidneys, lungs, and tissues like corneas and skin.

How does the heart offering process work?

After the identification of a possible donor, blood tests are conducted to check the suitability of the donor’s blood and tissues, and to check the function of their organs. Careful and detailed investigations are carried out to make sure that the heart will be a suitable match, these include a chest X-ray and an ultrasound scan to study the function of the heart. After this is tested and deemed suitable, the information is then passed on to the NHS Blood and Transplant, and a national computer program checks the national waiting list for suitable patients. The process of organ donation and allocation is one the most complex processes in the NHS. Patients are prioritised based on urgency level, their blood group, weight, and height of donor compared to the recipients, presence of antibodies in the recipient blood that may react to the donor heart and travel distance of the allocated heart to minimise adverse effects on the heart while transporting.

What happens if you are offered a heart?

If the patient’s name is on the top of the computer-generated list, their transplant centre will be contacted by NHS Blood and Transplant. The transplant team will make sure that the organ is suitable through a meticulous process that involves checking all the donor information and advanced lab testing. The patient will then be informed by their transplant centre to again confirm their suitability and to make sure the patient is prepared for surgery.⁶

How long does it take to wait for a heart?

Routinely, the average wait for a deceased donor heart transplant in the UK is 18-24 months. Some patients can wait longer and some can wait shorter, depending on an appropriate blood group, tissue type, and prioritising the patients on the waiting list.⁶

Risk of heart transplant

The surgery is an open-heart complicated surgery that has complications like bleeding, infection, and blood clots.

Other complication of heart transplant includes the following:⁷

• Rejection of the donor's heart: this can be prevented or minimised by giving the patient immunosuppressants.
• Primary graft failure: this is the main cause of failure in the first few months.
• Death
• Medication side effects: immunosuppressants can cause many complications such as kidney problems, decreasing the patient’s ability to fight infections, and lowering the immune system can increase the risk of cancer.

Recovery after a heart transplant

Recovery after a major surgery like a heart transplant can be challenging, commitment is crucial to ensure a healthy heart and a better quality of life after the procedure.

Here are the most important tips for a better recovery after the heart transplant:⁸

• Always take your medications on time, and consult with your doctor before adding any new medications.
• Make sure your diet is healthy, avoid salty and fatty diets, and take your daily requirements of vegetables and fruits.
• Exercise is very important to keep your heart healthy, consult with a professional before deciding your schedule.
• Always follow up, and inform your physicians of any changes you notice, or any new signs and symptoms.

Summary

A heart transplant is a complex life-saving procedure that is considered to be the last line of treatment for patients suffering from severe heart conditions when medications have proven ineffective. The process involves a careful evaluation of the patient's eligibility, matching with a suitable donor, and the surgery to transport the donor’s heart. The post-transplant care can include immunosuppressive medications to prevent rejection, and it also involves life modifications to ensure healthy habits to preserve a healthy heart. 

Many challenges face the heart transplants such as rejections, complications of immunosuppressive medications, and shortage of donor organs. Ongoing research and advancements like the use of artificial hearts and xenotransplantation (transplant from animals to humans) continue to shape the future of the heart transplant landscape and promise a better alternative for patients.

FAQs

How successful are heart transplants in the UK?

According to NHS Blood and Transplant:

Out of 100 patients, 85 are alive one year after a heart transplant.

Out of 100 patients, 72 are alive five years after a heart transplant.

How long does it take to recover from a heart transplant?

Every patient has a different pace of recovery according to their medical state before and after the surgery, but most patients are stable and functioning well after one year of the procedure.

Can I donate an organ after a transplant?

Yes, that is possible, your general health be assessed first, and then a decision will be made based on that. Visit the NHS Donor Register for more information.