Transplantation
Heart transplantation is a last resort for patients whose heart disease is no longer responding to drug therapy, and where there are no other operations or forms of treatment available. They fall into a category that is known as ‘end-stage heart failure’ and usually have a predicted life expectancy of less than a year. There are many causes for end-stage heart failure, but they all result in the heart’s inability to act efficiently as a pump.
Receiving a heart transplant is an enormous undertaking, and only some patients with end-stage heart failure are suitable, on both medical and physical grounds. It is well known that there is a great shortage of donor organs, so they are a very valuable commodity and must not be wasted. For this reason, anyone who is a potential recipient of a heart transplant must be thoroughly assessed at the transplant hospital to see whether they are suitable to go on the waiting list.
If you are referred for an assessment, you will be admitted to the transplant hospital for about three days, and go through a lot of tests and be seen by several doctors and other medical staff. At the end of your assessment, the transplant surgeon will look at all the test results and come and see you to discuss the findings. Some patients are thought to be ‘too well’ for transplantation, and others ‘too unwell’. If you are neither of these you will be put on the waiting list and be given a bleeper which will go off if a heart of the right size and blood group becomes available.
The actual operation can be long and often takes place in the middle of the night. This is because the potential donor needs to have ‘brain-stem death’ tests performed, and discussions with the relatives need to take place. This all tends to happen during the day and, by the time the transplantation can start, it is usually evening. It can be technically difficult if you have had previous heart surgery, and the normal anatomy has been destroyed. At the end of the operation you go to the ICU, and when everything is stable and your breathing tube has been removed you can be moved back to the ward. You are usually in the ICU a little longer than for other heart operations, because of the extra complications of the procedure and the longer period under anaesthetic.
Once you have had a heart transplant, you will find that your quality of life dramatically changes, and you can do things you never dreamed you would be able to do again. You must take a large number of tablets for life, however. The most important of these are the immunosuppressants that stop you from rejecting your new heart. You will have to take two or three different types of immunosuppressants every day for the rest of your life, but it is worth it because they are very effective. More than 80 per cent of all patients who have a heart transplant live longer than five years, and sometimes much longer.
