Heart Transplant

A heart transplant is an operation that removes a severely diseased heart and puts a healthy donor heart in its place, so the body once again has a pump strong enough to circulate blood normally. The heart is a muscular pump that drives oxygen-rich blood to every organ, and when its muscle is so weakened that it can no longer meet the body's needs, the result is heart failure that leaves a person breathless and exhausted by the slightest effort. When this failure reaches its final stage and cannot be improved by medication, a pacemaker or defibrillator, valve or bypass surgery or other measures, replacing the heart is the only lasting option. Unlike some organs, the heart cannot be donated by a living person, so a transplant relies on a heart from a deceased donor, matched to the recipient and transported and implanted within a few hours.

A heart transplant is considered for end-stage heart failure that no longer responds to the full range of other treatments. The most common underlying causes are a heart muscle weakened and enlarged by disease, known as cardiomyopathy, and severe coronary artery disease that has damaged the muscle beyond repair. Other reasons include congenital heart disease that cannot be corrected, valve disease that has led to irreversible failure, dangerous heart rhythms in a failing heart and, less often, the failure of a previous heart operation. A transplant is reserved for patients whose symptoms are severe despite the best medical and surgical care and whose outlook without a new heart is poor. The decision is made by a transplant team after a thorough assessment confirms that the heart cannot recover, that no lesser treatment will help and that the patient is otherwise fit enough to benefit from the operation and the care that follows.

A heart transplant is performed under general anaesthesia, so the patient is fully asleep and feels nothing. The chest is opened along the breastbone, and the patient is connected to a heart-lung machine that takes over the circulation and adds oxygen to the blood while the surgeon works. The diseased heart is removed, and the donor heart is sewn into place, with the major blood vessels and the upper chambers carefully connected so that blood flows correctly once more. When all the connections are complete and checked, the new heart is allowed to fill, and in most cases it begins to beat again, sometimes needing a brief electrical prompt. The patient is then gently weaned off the heart-lung machine as the new heart takes over the circulation. The operation usually takes about 4 to 6 hours. Because a donor heart must be used within a few hours of being recovered, the timing of the surgery follows the availability of a suitable organ rather than a planned date.

A candidate for a heart transplant goes through a detailed evaluation to confirm that the operation is both necessary and safe for them. This includes tests of heart function such as echocardiography and measurement of the pressures inside the heart and lungs, blood tests and tissue typing, screening for infection, and a careful check of the kidneys, liver, lungs and blood vessels to make sure the rest of the body can withstand surgery and lifelong medication. Psychological assessment and a transplant coordinator support the patient throughout. A transplant may not be advisable when there is active cancer, a severe uncontrolled infection, irreversible damage to other vital organs, very high pressure in the lung arteries that the new heart could not overcome, or active alcohol or drug addiction, or when a patient could not keep to the lifelong medication and follow-up that a transplant requires. Once accepted, the patient is placed on a waiting list and matched to a donor by blood group, body size and urgency. While waiting, some patients need a mechanical pump to support the circulation as a bridge to transplant. For international patients, much of the early assessment can begin remotely with records, scans and test results reviewed before travel.

Recovery from a heart transplant is steady and closely supervised. The recipient spends the first days in intensive care while the new heart settles and is monitored continuously, then moves to a specialised ward, and most people are discharged from hospital within about 2 to 4 weeks. Immunosuppressive medicines, which stop the body rejecting the new heart, are started straight away and must be taken for life, with the doses adjusted by frequent blood tests in the early weeks. Regular checks of the heart, including a small sample of heart tissue taken through a vein to look for early signs of rejection, are most frequent in the first months. Because of this, patients are usually advised to remain in the destination city for roughly 8 to 12 weeks after surgery so the team can monitor the heart, fine-tune the medication and confirm that the graft is stable before a long flight. Crowded places are best avoided in the first months while the immune system is suppressed. Once home, follow-up continues with a local cardiologist and remote review of results by the transplant team, and international patient services commonly provide interpreters and coordinators so language is never a barrier. Most recipients return to normal activity within 3 to 6 months.

A heart transplant is a major operation, and although modern transplant programmes achieve very good results, it carries real risks that the team works hard to manage. Early concerns include bleeding, infection, and a period in which the new heart needs support as it adapts to its new body. Rejection of the new heart is possible and is the reason immunosuppressive medication is essential and lifelong; these medicines themselves slightly raise the risk of infection, so the balance is monitored carefully with regular tests. Over the longer term, the medication and the transplant itself can affect the kidneys and the coronary arteries of the new heart, which is why ongoing specialist follow-up matters so much. With a well-matched donor heart, an experienced team and faithful follow-up, the great majority of patients gain years of active life, and many return to work, travel and the activities they had lost to severe heart failure.