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Heart transplants replace a diseased heart with a healthy donor heart, but there are far fewer donors than needed. Survival rates have improved due to research into reducing organ rejection. Eligibility is determined by specific criteria, including the degree of need and ability to care for oneself. The surgery is complex and requires significant follow-up care. Currently, about 70% of people who receive a heart transplant live five years after the surgery.
A heart transplant is the replacement of a diseased or failing heart with a healthy donor heart from a deceased person. Donor hearts are usually taken from people who have chosen to donate, have healthy hearts, and who are brain dead. There are far fewer donors than need transplants. Not all donated hearts can be used due to the condition of the heart at the time of death.
The first successful heart transplant was performed by Dr. Christian Barnard in 1967. In the early days of heart transplantation, the survival rate after a transplant was extremely low. It took about two more decades for scientists and doctors to successfully address one of the biggest problems with heart transplants, that the bodies of the people receiving them tended to reject the new organ. With considerable research into drugs that would help reduce organ rejection, survival rates after heart transplantation have steadily improved.
Most people who receive a heart transplant are under the age of 65 and have significant heart disease or defects that cannot or have not been successfully managed through other surgeries. There are very specific criteria for determining who gets a heart, and transplant coordinators have to assess the health of the person who needs the heart. A special balance is needed because the person usually needs the heart, which means that she is very ill, but she also needs to be healthy enough to survive the transplant surgery and subsequent treatment. Treatment after surgery may mean taking anti-rejection drugs that impact the body.
Another consideration is the degree to which the donor heart matches the person in need of the heart. Finding a heart that the body won’t reject can be difficult, and this is one of the reasons why many people wait a long time before receiving a donor heart. The degree of need is also measured. Sicker people tend to get hearts sooner if there’s a suitable match.
A corresponding consideration in adults is blood type, but very young children can sometimes receive hearts from people with a different blood type. As people get older, they cannot get these incompatible blood type hearts because their bodies will reject the new organ.
People who can receive a heart transplant also go through complex interviews in which the ability to take care of themselves and things like mental stability are determined. In cases where children will receive a heart transplant, families are interviewed and their interviews help determine eligibility. Physicians always want to be certain that a person receiving a heart or the family members who care for this person will be able to comply with all medical requests and instructions to improve survival.
Heart transplant surgery is very complex. The old, diseased heart is mostly removed, although usually a small amount of the left and right atria, the heart’s two upper chambers, are not removed. The new heart is connected to the atria and blood vessels that feed the body and lungs. While surgeons are removing the old heart, people undergo heart-lung bypass, which circulates blood and oxygen.
Once the new heart is in place, it may need help to start beating, which is sometimes achieved through an electric shock. The surgery takes about five hours, but it can be longer or shorter depending on the complications or ease of the surgery. After surgery, people will need care for several days in the hospital to make sure the new heart continues to function normally and to recover from the surgery. People will continue to need significant care and follow up with their doctors throughout their lives.
Currently, about 70% of people who receive a heart transplant live five years after the surgery. Survival rates are expected to increase and there is always new information to help improve this field. For example, in 2008, it was found that survival increased for those people who had received a donor heart from someone of the same gender. It is conceivable that donors could one day be matched by gender. At present, the limited availability of donor hearts would make gender matching unlikely.
