What is a heart transplant?
A heart transplant is the replacement of a person’s diseased or damaged heart with a healthy 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 means the heart is unable to pump properly. Causes include:
- coronary artery disease;
- cardiomyopathy (a heart muscle disease);
- heart valve disease; and
- inherited forms of heart disease.
Although there are treatments that can help many 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 for people with advanced heart disease. The average survival for people following heart transplantation is 14 years, and one-third of heart transplant recipients survive more than 20 years.
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, or other treatments are no longer effective.
Recipients must also be non-smokers, not drink alcohol to excess and not take illicit drugs.
People who are eligible for a heart transplant are put on a waiting list. When a donor heart becomes available, it usually is given to the person on the list who is the most unwell, and who has a similar body weight as the donor as well as a matching blood group.
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?
During heart transplant surgery, the person is placed on a heart-lung machine. 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.
Because the body recognises the transplanted heart as foreign tissue, the immune system will try to reject it. For this reason, heart transplant recipients need to take anti-rejection medicines called immunosuppressants for the rest of their life.
Even with the use of immunosuppressants, some form of rejection is common, especially in the first few months after transplant. Usually there are no symptoms with mild rejection, so frequent monitoring is needed. Most cases of rejection can be treated by adjusting your medicines. Heart transplant recipients should be aware of symptoms that can indicate rejection.
Anti-rejection medicines can themselves cause side effects, so you may be prescribed other medications to combat these problems as well.
After the transplant
Most people need to stay in hospital for one to 2 weeks after their surgery. At first, you will need to see your doctor frequently, but after the transplant has settled, they may eventually need to be seen by a specialist only for an annual check-up.
Most people who have a transplant are able to lead a normal lifestyle after the surgery, including going back to work and participating in sports. However, the outlook depends on many factors, such as your age, general health and your body's response to the transplant. Ask your doctor about support groups for people who have had a heart transplant – this can help with adjusting to life after a transplant, especially if you are feeling stressed or overwhelmed.