Heart Transplantation: A Life-Saving Procedure

The Function of the Heart

• The heart beats over 100,000 times a day.
• It pumps more than five liters of blood each minute.
• Limited ability to repair itself, unlike skin and bones.

Heart Transplantation Overview

• Approximately 3,500 heart transplants conducted annually.
• Complex procedure with no room for error.

Eligibility and Matching Process

• Recipient Testing: Patients must be healthy enough for the procedure.
  • Screening for immunocompromising illnesses and other conditions.
• Donor Matching:
  • Donors usually comatose patients or victims of a fatal event.
  • Must be registered organ donors or have family consent.
• Compatibility Requirements:
  • Blood type and antigens must match between donor and recipient.

Surgical Procedure

1. Preparation:
   • Confirm the donor's heart is healthy.
   • Heart is immersed in ice slush and injected with cardiac arrest solution.
2. Heart Preservation:
   • Stored in cold saline and preservation solution.
   • Limited viability outside body; must be transplanted quickly.
3. Operation:
   • Recipient put under general anesthesia.
   • Incision made through chest, rib cage separated.
   • Use of cardiopulmonary bypass machine to maintain blood flow.
   • Precise sewing of donor heart into recipient's body.

Post-Operation and Recovery

• Initial monitoring to ensure the new heart beats on its own.
• Heart not initially connected to recipient’s nervous system.
  • Innervation Period:
    • May take years for body's full integration.
    • Higher resting heart rate, risk of stroke.
    • Challenges for exercise.
• Immunosuppressive Drugs:
  • Manage rejection risk but increase infection susceptibility.
  • Requires ongoing monitoring and testing.

Outcomes and Challenges

• Survival Rates:
  • ~70% survive at least 5 years.
  • Over 20% survive additional 20 years.
• Accessibility Issues:
  • Limited access in developing countries.
  • Legal and regulatory barriers prevent some viable hearts from donation.
  • Many remain on waiting lists for suitable donors.