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What is a heart transplant?

A heart transplant is a surgical procedure for patients with end stage heart disease. Their hearts are so severely damaged that maximum medications, pacing devices, and surgical repair cannot help to prolong life. A new heart is needed to prevent death.

There are two types of heart transplantations:
  • Orthotopic: The diseased heart is cut and discarded. Then a new heart from a Donor, who is brain stem dead, is stitched in its place.
  • Heterotopic: Also called “piggy back” heart transplantation. In this the diseased heart is left in the chest in its original place. A new heart from the donor is piggy backed on the old heart. This is called Heterotopic Heart Transplantation.

Orthotopic Heart Transplantation is the one that is commonly done.

How is Heart Transplantation done?

The patient is placed under general anesthesia, an incision is made through the breastbone. The patient's blood is re-routed through tubes to a heart-lung bypass machine, which will function like the heart and lungs, while the diseased heart is cut out and the new heart from the donor is stitched in its place.

How will a transplant change my life?

A successful transplant will dramatically improve your symptoms of heart disease. It will give you a new lease on life; a second chance to live. Many transplant recipients can perform the same physical activities and enjoy the same quality of life as normal people.

In life there is day and a night. Even where there is a tide there is an ebb. Duality enfolds nature. For every advantage there is a disadvantage. For example, if you take Aspirin it will reduce your headache, but will increase your acidity. So Heart Transplantation has advantages and disadvantages.

All transplant recipients, however, need to take medicines daily. Each medicine has its characteristic side effect. Therefore you need to be under close medical supervision for the rest of your life.

What is the success rate of Heart transplants?

According to the International Society of Heart and Lung Transplants (ISHLT), 85-90% one year survival, 50-60% 10 year survival

If I have end stage heart disease, and I have been advised Heart Transplantation by my Cardiologist, how can I get this Heart    Transplantation?

You will be evaluated by the Heart Transplantation Team at any hospital approved for it, then you will be listed for Heart Transplantation with the Cadaver Transplantation Program of Tamil Nadu. This will be done by a deposit of a Demand Draft (DD) of Rs. 1000/= {Rupees one thousand only} in favor of “Transplant Authority of Tamil Nadu” . This will be done by the Transplantation Coordinator of your institution. This registration is not applicable to patients who are listed through the Government Hospital.

What is Evaluation for Heart Transplantation?

The transplant evaluation is done so that doctors ensure that you get maximum benefit from the surgical procedure.

In addition to specific heart assessment, tests are performed to determine the function of all the major organ systems. You will be screened for infectious diseases and cancer. Your cognitive functions will be tested by a Psychologist. Thus the team will be able to judge, whether you will be able to be comply with the complex medical regime after your Transplantation.

Your anxiety and stress will be evaluated by a Psychiatrist. Your family support will also be assessed. Most tests can be done in the outpatient division; you may not need to get admitted for them. You may require to be admitted briefly to the hospital for some tests.

Typically, most of the evaluation can be completed within a week.

The transplant teams will meet to discuss patients under evaluations. Patients who are felt to be good candidates for transplantation are then put on a state waiting list.

How do I get on the state waiting list?

You first decide the hospital in which you wish to get your Heart transplanted. Then, after evaluation, the Transplantation Team of your hospital will ask your Transplantation Coordinator to put you on the wait list by paying a onetime fee through a DD of Rs. 1000/- in favor of “Transplant Authority of Tamil Nadu.”You are then registered. You will receive your wait list number from your Transplantation Coordinator. The Transplant Coordinator will assist you with all logistic issues related to your Heart Transplantation.

What is the recovery process after a heart transplant? How long will it take to recover?

When surgery is completed you will be taken to the intensive care unit. Over the following days as you recover from surgery, the various tubes and intravenous lines will gradually be removed and rehabilitation will begin. You will be closely monitored and evaluated to make sure your body is accepting the new organ. This includes regular heart echocardiograms, electrocardiograms and biopsies.

You are likely to be mobilized in the first couple of days. Most patients are able to walk in three or four days. Most patients are discharged from the hospital by two to three weeks after their Heart Transplantation.

Once you are discharged from the hospital, the medical team will encourage you to become increasingly active by starting Cardiopulmonary Rehabilitation. This should continue till you are able to resume your normal life once again.

How long will I be in the hospital after the surgery?

The average length of stay in the intensive care unit is 3-7 days, followed by 1-2 weeks in the hospital.

What happens while I am waiting on the heart transplant waiting list?

While waiting, you will be seen in the clinic periodically to assist with any medical issues that may arise. Almost every patient will need to have a right heart catheterization and other tests every three to four months. These tests are important to help the doctor know whether problems are developing that could complicate a transplant, or move you ahead in priority for a new heart.

Some programs have regular weekly meetings of all patients on the waiting list and those who have already received heart transplantation. If your program has such group meetings, it will be beneficial for you to attend them. These group meetings provide great psychological support and create a non stressed, informal atmosphere for learning complex transplantation related issues. They also provide mutual motivation. You can also meet your entire Transplantation Team in a relaxed atmosphere.

How will I get the Heart once I get on the wait list?

Whenever there is a brain stem dead donor in any of the participating hospitals, the transplantation coordinator of that hospital has to inform the TRANSTAN office of this donor. Once consent is given by the family, the TRANSTAN office will allocate the organs according to the established guidelines and your doctor will decide on the suitability of the organ for you based on medical criteria.

If the organ is allocated to you, your hospital transplant coordinator will call to inform you. It could be at any time of the day or night.

You need to keep your bag packed with all your reports, X-rays, medications and your personal toiletry so that you can reach the hospital as soon as possible.

How long must I wait for a donor heart?

Not very long. Your doctor will be the best person to assess this for you. If your heart failure has reached a very severe stage ( there are criteria to judge this) your doctor will put you on the Urgent list and you will be allocated the next available donor heart suitable to you.

Is the surgery very complicated?

Risks and the benefit of the operation will be explained to you by the Transplant Team as it applies to you.

How often will I have to come back to the hospital after my transplant?

Initially, follow-up care involves returning to the outpatient clinic once a week for the first month after leaving the hospital. At this time a series of tests are given to closely monitor your progress. At this time, medications will be precisely adjusted. After this initial period, patients will be seen periodically (bi-weekly, then monthly, then quarterly) over the first year. Thereafter scheduled visits may need to occur less often, depending on the particular patient's condition.

Do I have to stay near the hospital after the transplant?

Most patients are allowed to go home after they have recovered from the transplant surgery. Although there is no specific requirement about staying close to the hospital during the initial period after transplantation, the frequency of follow-up visits and lab tests during this interval can be a problem for patients who live far away. The social worker can help you locate suitable guest housing in the area.

Will I have pain after the surgery?

Generally, most patients do not report much pain after heart transplant surgery. The incision does cause pain or discomfort when you cough. The doctors will give you pain medication and specific instructions to lessen the pain.

What will my scars look like?

The scar is down the center of the chest. It starts at the supra sterna notch, or top of the sternal bone, just under your neck, and ends just past the end of the sternal bone. Initially the scar will look prominent. Over time, it will fade to a very light, thin line.

Will I have to take medications for the rest of my life?

Yes. This is very important. It is necessary for all patients to take immunosuppressive medications for the rest of their lives following transplant, because the medications help to prevent rejection of the heart. Unfortunately, it is very rare that a patient becomes "tolerant" of their new heart. A successful transplant can be undermined very quickly if patients fail to take their medications appropriately and responsibly.

What is rejection?

In your blood there are red blood cells and white blood cells. The red blood cells carry oxygen. The white blood cells protect you from bacterial invasion by killing the bacteria. Now when a new heart is placed in your body, the white blood cells identify it as a foreign protein, as they come to know that this heart does not belong to this body. So they communicate with each other by releasing chemicals called cyctokines, and increase the number by rapid reproduction. Then they come to attack the new heart. This is called rejection.

What are immunosuppressive drugs?

These are a group of medicines that reduce the number of white blood cells in the body. They must be taken for life. They cannot be stopped at any time without the permission of one of the transplant doctors. Different programs have different regimes.

When can I drive?

After heart transplantation, you can drive when your sternum, or breastbone, is fully healed. This takes about 4 months to get full tensile strength. It is safe to wait for four months.

When can I return to work?

You may return to work two to three months after the transplant surgery.

How long does it take to fully recover?

It generally takes three to six months to fully recover from heart transplant surgery. However, age and previous medical problems may cause a longer recovery period.

Who pays for the costs of transplant and other medications?

For patients undergoing transplant
  • In Government hospitals (GH ) Free transplant and free immunosuppressive medicines for life.
  • In private hospitals ( which are approved for Transplant under the CM Comprehensive Health scheme), poor patients holding CM Comprehensive Health scheme cards, free transplant and free immunosuppressive for 1 year.
  • In private hospitals for any other patient transplant cost will vary from hospital to hospital. You should enquire with the hospital you are considering for your heart transplant.

What happens if I change my Hospital?

You are at liberty to shift to any hospital (approved by Government for transplant) of your choice in Tamil Nadu

You can change your hospital and request the new hospital to send in your detail to the TRANSTAN office by mail and you will need to send a handwritten letter requesting to change your registration from the old hospital to the new one with all details.

What types of costs are associated with transplant?

There are several phases in the transplant process. It may be helpful to break down these costs by looking at these phases.

The first costs are those associated with the pre-transplant evaluation, which would include all the tests necessary to determine if you qualify to be on the waiting list. There may be costs of hospital admission for medical treatment and stabilization before your transplant.

After that, when you are called in for your organ transplant, you will incur the costs of hospitalization, transplant surgery and various professional and facility fees. Due to the wide variety of patient conditions and treatments, it's very difficult to give an average total cost for the aforementioned treatments. Each case and each patient's condition is different.

If you have rejection or infection you may need to be readmitted to ICU or Wards. The cost of Immunosuppressive Medications. Cost of Medication for prevention and protection against Bacterial Viral and Fungal infections. Costs of Biopsy and right heart catheterization that may be done monthly by the program of our choice.

You need to discuss all of this with your chosen hospital at the very beginning.