Heart transplants
What is a heart transplant?
A heart transplant is the replacement of a person’s diseased or damaged heart with a normal one from someone (a donor) who has died.
The first human heart transplant was performed in South Africa in 1967, and Australia’s first heart transplant took place in Sydney in 1968. Since then, heart transplants have changed from being experimental procedures to established medical treatments for advanced heart disease.
Who needs a heart transplant?
People who have developed heart failure may need a heart transplant. Heart failure, which can occur when the heart has been severely damaged by coronary artery disease or cardiomyopathy (a condition that weakens the heart muscle), means the heart is unable to pump properly. Other causes of heart failure may include viral infections, leaking or blocked heart valves or genetic forms of heart disease.
Although drug treatment can help some people with heart failure, others do not benefit and for them a transplant may be the best option.
Overall, heart transplantation is generally a successful procedure. The National Heart Foundation estimates that the average heart transplant can be expected to last between 10 and 20 years. After transplantation, 90 per cent of patients are still living after one year, and after 10 years, 70 per cent of transplant patients are still alive.
Before someone is accepted for a transplant other organs such as their kidneys and liver must be functioning normally. The person must have given up smoking and excessive alcohol, and be willing to look after their new heart.
What are the criteria for heart transplant recipients?
Usually, to be eligible for a heart transplant, potential recipients must:
- be suffering from end-stage heart disease;
- be in good health, apart from heart disease;
- be likely to die without the transplant;
- be able to cope with the drug treatments and examinations required after a transplant; and
- be unsuitable for other therapies.
After a person has been assessed as being suitable for a heart transplant they are put on a waiting list. When a donor heart becomes available, it usually is given to the sickest patient with similar body weight and matching blood group as the donor.
What are the criteria for heart transplant donors?
Donors are individuals who are brain-dead, meaning that the brain shows no signs of life while the person's body is being kept alive by a machine.
Donors are in short supply. Only a fraction of those who could donate organs actually do, and there are not enough organs available for transplant. Before organs can be donated, the donor’s next of kin must give consent.
What happens during a heart transplant?
The operation itself usually takes between 3 and 6 hours. The person is placed on a heart-lung machine that keeps them alive by bypassing the blood flow to the heart and lungs. The machine shunts blood away from the heart, artificially oxygenates it and pumps it back into the body.
Most often the damaged heart will be removed through an incision in the chest and replaced with the donor heart. Sometimes, in a less common procedure, the old heart is left in place and the donor heart attached to it so that it can act as an ‘assist pump’ for the damaged heart. After the replacement, surgeons connect up the blood vessels and allow blood to flow through the new heart. After the heart has started beating, the patient is removed from the heart-lung machine.
Rejection
Because the body recognises the transplanted heart as foreign tissue, the person’s immune system will try to reject it. Although a person might not be aware that this is happening, because sometimes no symptoms are apparent, most people experience some form of rejection, particularly in the first few months after the transplant.
Anti-rejection drugs have significantly improved the survival rates of transplant patients in the past few years. Someone who receives a transplant will usually need to take anti-rejection drugs called immunosuppressants for the rest of their life.
These anti-rejection drugs can themselves cause side effects, so the person may be prescribed other medications to combat these problems as well.
After the transplant
Most people need to stay in hospital for about 8-10 days after their surgery. At first, the person will need to see their doctor often but after the transplant has settled, they may eventually need to be seen by a specialist only for an annual check-up.
More than three-quarters of people who have a transplant are able to lead a normal lifestyle after the surgery, including going back to work and participating in sports. It is often even possible to go back to occupations that involve manual labour. However, the outlook depends on many factors, such as age, the general health of the person who has had the transplant and the body's response to the transplant.
Last Reviewed: 07 September 2009
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