Heart is a muscular organ – about the size of a clenched fist – which is located in the middle of the rib cage. Heart works non-stop, pumping around 2,000 gallons of blood throughout the body without a rest on a daily basis. As a matter of fact, over the average lifetime, the heart beats around 2.5 billion times circulating nearly 50-65 million gallons of blood. That being said, the blood that heart circulates is crucial as it carries various nutrients and oxygen to other organs and tissues in your body while absorbing waste products and carbon dioxide.

However, if care is not taken, factors such as high cholesterol, obesity, and high blood pressure coupled with vices such as smoking and excessive consumption of alcohol can severely damage your blood vessels and there on, your heart.  A heart disease or an injury to the heart can result in your heart getting weakened thus affecting its ability to provide your body’s organs enough blood to work efficiently at the optimal level. It therefore goes without saying that the heart is the most valuable organ in the body which makes it imperative to treat it like the precious commodity it is.

What Happens When The Heart Does Not Function Optimally?

Being diagnosed with heart failure means that your heart is unable to pump enough blood to effectively cater to your body’s need.  However, this doesn’t mean that your heart is about to stop – it simply means that the main pumping chambers in your heart have become too stiff and can no longer pump with adequate force or that your heart is no longer able to fill itself up with enough blood between beats.  In addition, it needs to be mentioned that a heart failure can affect either side of the heart or even both sides as evident in many cases. The most common conditions that cause heart failure are given below:

Coronary artery disease

High Blood Pressure

Leaking or blocked heart valves.

Cardiomyopathy

Viral heart infections

Inherited forms of heart disease

Congenital heart disease

Children administered certain medicines for leukemia

Women whose hearts have been weakened by pregnancy/childbirth

WHAT IS A HEART TRANSPLANT? WHO NEEDS A HEART TRANSPLANT?

A heart transplant is a surgical operation where in a damaged or diseased heart is replaced with a healthy donor heart. In case you have been diagnosed with end-stage heart failure and in need of life-saving treatment, you may be considered for a heart transplant. A transplant may also be suggested if your heart can no longer work well and if you’ve tried all other available treatments. When the heart starts failing other organs like kidney liver brain lungs  also get affected. The transplant needs to be done before other organ damage starts. If a heart failure is not treated on time, it can lead to several complications while severely hindering your ability to perform any physical work. It could also cause intense breathlessness which could even wake you up from sleep. Some patients present at late stage of heart failure whose lung pressures become high may require artificial hearts or LVAD

SUITABILITY FACTORS FOR A HEART TRANSPLANT

A team of transplant doctors will initially assess your eligibility for a transplant. You will be then explained about all the risks involved and asked if you would be willing to take responsibility for the self-care required once the operation is completed. The medical team will also evaluate your medical history, test results, social history, and conduct psychological tests to analyze where and how you might need support during and after your surgery.

Thereafter, if you are deemed suitable and willing to have a transplant, you will be put on a waiting list. Once a donor's heart becomes available for you, you will probably be asked to visit the concerned hospital. More often than not, a heart is donated based on the level of urgency and according to the severity of their medical condition meaning the sickest person is the first one to be called to have a heart transplant.

The donated heart will be from an individual who has recently passed away and whose family have agreed to donate their heart. Moreover, when a heart becomes available for donation, factors such as whether it matches your blood group, your weight and size will be taken into consideration. Further, your other organs, such as kidneys and liver, should also be working normally in order to be eligible for a donation.

What Happens In A Heart Transplant?

Once you have been ear marked for donation, things move along pretty quickly. You should be prepared to come in for surgery no matter what time of the day it is. You will also be required to fast before surgery. Once in the treatment room, wide array of tests are performed before the procedure to ensure the operation goes smoothly. A nurse or doctor will also ask you to provide informed consent – a mandatory requirement before the procedure is performed. You will then be placed under general anesthesia and remain unconscious for the entirety of the procedure. In most cases, a heart transplant takes anywhere between 5 to 7 hours. There are two types of heart transplants:

 ORTHOTOPIC HEART TRANSPLANTS

Recognized as the most common type of heart transplant, this procedure involves removing your diseased heart by making an incision down the center of your chest. This is done to open the rib cage and access your heart following which your old heart is replaced with the donor's heart.

HETEROTOPIC HEART TRANSPLANTS

A slightly rarer operation, a Heterotopic heart transplant procedure involves attaching the donor’s heart to your old heart. In such a scenario, the donor’s heart doubles up as an assist pump for your diseased heart.

Post surgery, you will be confined to the ICU and monitored closely. You will also be immediately put on anti-rejection medications after the surgery which must be continued for the rest of your life. Consequently, you will probably stay in the ICU until the doctors think you’re well enough to be moved to a regular hospital bed.

Additionally, you will be closely monitored by specially trained medical and nursing staff including dieticians, pharmacists, physiotherapists. You’ll also be made to undergo regular blood tests, chest X-rays and ECGs to ensure that your body is not rejecting the donor organ. In all likelihood, you will be required to stay in the hospital for a few weeks to recover.

Life After A Heart Transplant

Every patient is different but most individuals report feeling much better after the transplant. Thereafter upon discharge, your road to recovery begins. This means that you will be required to attend all your medical appointments to protect your new heart. You will also be needed to follow and adhere to any health and lifestyle advice given to you by your physician while participating actively in rehabilitation and exercise programs. This step is referred to as cardiac rehabilitation.

The ultimate goal of the transplant is for you to return to a normal lifestyle so, with time, you can be physically and socially active, resume work and enjoy a better quality of life. To make sure that your rehabilitation goes as per plan, you should take extra precaution and avoid exposure to germs that could cause illness. You should also aim to maintain good food hygiene while preparing your meals. After all, your immune system has weakened a bit so by doing your bit and taking necessary precautions, you can avoid any possible complications and avoid the unpleasant scenario of your body rejecting your new heart.

• Dr Suresh Rao KG, MD, Head of Department, Critical Care & Cardiac Anaesthesia, Fortis Malar Hospital