Heart Transplantation: Treatment, Effects & Risks

Heart transplantation is the transplantation of organs from a donor to a recipient.

What is heart transplantation?

In a heart transplant, the still-active heart of a donor is implanted in a recipient. In a heart transplant, a donor’s still-active heart is implanted in a recipient. A heart transplant is mainly necessary in cases of heart failure, when the survival rate is less than one year. This is calculated with the help of a score, using the following parameters:

  • The mean blood pressure
  • The heart rate
  • The maximum oxygen uptake
  • The ejection fraction
  • When there is a block pattern in the ECG
  • The pulmonary capillary occlusion pressure

Function, effect and goals

Chronic or acute heart failure is always initially treated with medication, which can stabilize patients. In some cases, however, stabilization is unsuccessful, necessitating heart transplantation. A transplant is particularly necessary if the heart muscle is irreversibly damaged, all treatment options have been exhausted, and the life expectancy of the affected person is significantly reduced as a result. In this case, patients are placed on a waiting list for transplantation after consultation with the cardiologist. The waiting time depends on the size, weight and blood type of the organ recipient. Until transplantation, the time can possibly be bridged with an artificial heart, but this only supports the patient’s weak circulation. However, an artificial heart cannot be used for a longer period of time; the maximum duration is about three years. Transplants are rejected if the recipient is not willing or able to cooperate with the necessary examinations or treatment. Another important criterion for organ allocation is the prospect of success based on the Transplantation Act. If all conditions for an operation are met, the patient is also registered with Eurotransplant, where all potential recipients of donor organs are recorded. On average, patients wait several months for a transplant, with priority given to very critical cases. Due to the unpredictable availability of a suitable donor organ, surgery cannot be planned and therefore always occurs acutely. Therefore, interventions can take place on weekends or at night. The organ recipient is immediately ordered to the hospital and the clinic organizes the organ removal or the transport of the donor organ, which is often hundreds of kilometers away. Since an explanted heart can survive outside the body for only a few hours, communication must be perfectly coordinated. After the donor heart is removed, it is preserved in a four-degree cold solution and transported to the recipient. The explanting physicians also check the quality of the organ. If there are concerns about the function of the donor heart, the operation can still be aborted without harming the recipient. In order to avoid long journeys, a suitable recipient is first sought in the donor’s vicinity. The heart is not removed until the transplant can take place within the next four hours. When the donor heart arrives at the hospital, the removal of the diseased heart begins. During this time, the blood supply to the organs is taken over by the heart-lung machine. The veins leading to the systemic circulation or to the lungs are cut by the surgeon in such a way that a part of the right or left atrium remains. The donor heart is then sewn to the tissue remnants. The new heart is connected to the bloodstream and can then resume pumping. After the heart transplant, intensive therapy is followed, which lasts about seven days. Organ recipients are immunosuppressed to the maximum extent possible to prevent organ rejection. The risk of infection is highest during this time, so patients must be isolated. The rejection crises mostly occur in stages. If they occur about every two weeks during the first three months, stabilization occurs after some time.This is followed by rehabilitation on the normal ward, which lasts about three to four weeks. In the first year, regular check-ups are also necessary. The physician takes tissue samples from the heart in order to record the immunosuppression. The tissue samples enable him to determine whether the organ may be rejected. If rejection is moderate or severe, patients are treated with cortisone.

Risks, side effects, and hazards

Heart transplantation is a procedure that carries certain risks. The surgical technique is not difficult nowadays, but bleeding, thrombosis or wound healing problems may occur in the first weeks after surgery. The immunosuppressive drugs also weaken the immune system, increasing the risk of possible infections. Furthermore, not all patients are suitable for transplantation; the risk rate is increased by the following circumstances:

  • Diseases of the liver, lungs or kidneys
  • Diabetes
  • Vascular diseases of the leg or neck arteries.
  • Drug or alcohol abuse
  • Age of more than 60 years
  • Acute pulmonary embolism
  • Certain systemic diseases such as tissue degeneration.

It is important that patients themselves monitor their bodies very closely to notice any change. Possible symptoms that may indicate rejection are:

  • Weight gain due to water retention in the body
  • Shortness of breath
  • Temperature rise
  • Cardiac arrhythmia
  • Lower resilience