Heart Transplant: A gift of life.

Heart disease is a leading cause of death worldwide, and in its end stages, a heart transplant can be a life-saving option. India has made significant strides in the field of heart transplantation, offering hope to patients with severe cardiac conditions.

The first heart transplant in India was performed in 1968, but the procedure didn't become more established until the 1990s. Passing the Transplantation of Human Organs Act in 1994 was crucial in enabling deceased donor organ transplantation. Since then, India has witnessed a steady increase in successful heart transplants, thanks to advancements in medical technology, surgical expertise, and post-transplant care.

Heart failure diagnosis and need for transplantation :

Heart failure occurs when the heart is unable to pump blood efficiently, leading to fatigue, fluid retention, and other severe symptoms. Diagnosis often involves an echocardiogram, which measures the heart's Ejection Fraction (EF) — a critical indicator of heart function. Additionally, the presence of NT-pro BNP (N-terminal pro-B-type natriuretic peptide) in the blood signals heart distress, commonly seen in heart failure patients. For patients with end-stage heart failure who don't respond to medical management, heart transplantation may be the only option for survival. These patients are added to a national transplant waiting list, and a donor's heart is matched based on various factors such as urgency, age, blood type, and body size.

The process of donating a heart for transplant :

Donating a heart occurs when a person is declared brain dead but remains on a ventilator, allowing their heart to stay oxygenated. Heart donation is critical to the success of heart transplants, but the demand far outweighs the number of available donor organs.

When a donor heart becomes available, recipients are matched based on several factors, including:

• Compatibility based on blood group, height, weight, body surface area, matching of donor and recipient along with predicted heart mass calculation.
• Cross match - Donor and recipient blood cross match. If cross-match is good, only then the process of transplant goes on.
• Clinical condition of the recipient.
• Proximity of the organ/retrieval center - This determines ischaemia time which has a significant role in determining the outcomes both short and long term.

This matching system ensures that the heart is most suitable for the recipient, optimising the chances of a successful transplant.

Donor assessment and recipient preparation :

Before transplant surgery can proceed, both the donor and recipient undergo extensive assessments:

• Donor evaluation: A series of tests, including echocardiographic, hemodynamic, hormonal, and infectious disease screenings, are performed to assess the donor heart's viability. It ensures the organ is healthy and free from any condition that could jeopardise the transplant outcome. Additionally, donor resuscitation protocols are implemented to improve the quality of the organ and enhance the chances of a successful transplant.
• Recipient preparation: The recipient undergoes a thorough evaluation to ensure they are fit for the procedure. It includes physical, psychological, and functional assessments. In critically ill patients, devices like ECMO (extracorporeal membrane oxygenation) or VAD (ventricular assist devices) may support circulation until a suitable donor heart becomes available.

Heart transplant surgery :

Once a suitable donor heart is found, transplantation begins with its removal, cooling, and preservation. During surgery, the patient is placed on a heart-lung machine, which maintains blood circulation and oxygenation while the heart is removed and replaced.

During surgery:

• The recipient's heart is excised, leaving the atrial walls intact.
• The donor's heart is connected to the remaining atrial walls, the vena cavae (large veins on the right side), and the pulmonary arteries.
• The heart-lung machine is gradually removed, allowing the donor heart to begin pumping blood and restoring circulation.

This complex procedure typically lasts 4 to 8 hours, depending on the patient's condition and the complexity of the surgery. Most recipients can begin to walk within a few days and are typically discharged from the hospital within 10 to 15 days after surgery.

Post-transplant protocols and long-term care

A successful heart transplant is more than just surgery — it requires diligent follow-up care to ensure the transplanted heart is functioning correctly and to prevent complications. Post-transplant protocols focus on several key areas:

• Immunosuppressive therapy: To prevent rejection, recipients must take immunosuppressive medications for the rest of their lives. These medications suppress the immune system, preventing it from attacking the new heart. However, this makes the patient more susceptible to infections and other complications.
• Surveillance and monitoring: Continuous monitoring is essential. Endomyocardial biopsies are performed regularly to detect signs of acute rejection. At the same time, advanced imaging techniques like optical coherence tomography (OCT) are used to monitor chronic rejection and cardiac allograft vasculopathy (CAV), where the coronary arteries of the transplanted heart become damaged over time.
• Infection control: Due to immunosuppressive medications, transplant recipients are at a heightened risk of infections. Prophylactic measures, including vaccinations and antibiotics, prevent infections, while regular follow-up appointments help detect potential issues early.
• Hormonal and metabolic balance: Post-transplant patients may develop hormonal imbalances, such as diabetes or osteoporosis, due to immunosuppressive drugs. Ongoing monitoring and management of these conditions are crucial for long-term health.

The heart transplant team :

A heart transplant involves a diverse and skilled team of specialists to ensure the best outcome. It includes professionals from:

• Heart transplant surgeon, heart failure cardiologist and transplant anaesthetist/ intensivist, perfusionist for the transplant process.
• Infectious disease experts to manage infection risk.
• Nephrology for kidney function monitoring, as immunosuppressive drugs can impact renal health.
• Pulmonology to monitor respiratory function.
• Endocrinology to manage metabolic changes.
• Critical care and cardiac anaesthesiology will provide support during surgery and in the ICU.

A leading heart transplant hospital in Gujarat.

In a nutshell:

Heart transplantation is a highly specialised and complex process that extends far beyond the surgery itself. Our trained and dedicated team at KD Hospital works from the initial diagnosis of heart failure through donor matching, surgery, and intensive post-operative care; each phase plays a critical role in the success of the transplant. We have specialised transplant OT, ICU and experts who give 24 X 7 care to the transplant patient.

While the path to a heart transplant is filled with challenges, the advances in medical technology and patient care protocols have made it a viable option for many. With ongoing advancements in both surgical techniques and post-transplant care, heart transplantation continues to save lives and offer hope to those in need.