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Heart transplants - how are they done?

Doctors at the Hyderabad based Apollo Health City performed a heart transplant on a 19 year old boy. Learn more about the procedure.

Written by Pavitra Sampath |Updated : May 22, 2014 1:43 AM IST

heart transplantRecently a 19-year-old boy, Veer Anjaneyulu, a pharmacy student got a new lease on life. Suffering from a debilitating condition of the heart, Veer was left feeling constantly breathless, weak and with severe swelling all over his body. He says that he had lost all hope, until doctors at the Hyderabad based Apollo Health City performed a heart transplant on him.

Veer was suffering from a condition called dilated cardiomyopathy, a disease where the muscles of the heart are severely affected leaving the patient with an extremely weak and overworked organ. In Veer's case medication did not help and he urgently needed a heart transplant.

In a country where doctors estimate that there is a need for 50,000 to one lakh heart transplants a year, out of which only 100 such surgeries were carried out. Spreading awareness about organ donation and the knowledge about a procedure like a heart transplant is the need of the hour.

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Veer was lucky; he got a donor heart within eight minutes from a deceased donor whose family decided to donate his heart. But there are a large number of people still languishing in hospitals, waiting for the right donor to come along.

In an attempt to increase awareness about the heart transplant procedure, here is a quick guide on what a heart transplant actually is.

A heart transplant is a procedure where the heart of a donor is removed and placed in an individual in need of the organ. It is a relatively easy procedure for a qualified surgeon and is roughly divided into three parts.

What does the surgery involve?

The first part of the surgery involves the harvesting of the heart from the donor. A donor is someone who has had a major trauma and is brain dead (the person's brain is irreversibly damaged and cannot be revived). The donor is decided upon by performing a number of blood tests that are aimed at matching the donor and the recipient. The person's body is kept alive with the help of machines that pump blood and oxygen through their body so as to keep their organs viable for transplant. The doctor goes to the hospital where the patient is and with the consent of the person's family, harvests the organs to be donated. These organs are then kept on ice and quickly transported to the patient waiting for the organ. There is only a small window of time that a harvested organ can be used efficiently and in the case of a heart it is approximately six hours after harvest. (Read: Organ donation all your queries answered)

The second part of the surgery is where the patient requiring the organ undergoes a surgery to remove his/her damaged heart. This surgery may take a while depending on whether the person has had previous heart surgeries. Previous surgeries increase the amount of scar tissue that forms around the heart which makes it difficult for the surgeon to remove the heart.

During the removal of the damaged heart and replacement of the new heart the patient is put on a machine called a bypass machine that helps in circulating blood and oxygen throughout the patient's body.

Once the damaged heart is removed the third part of the surgery begins. Here, the surgeon places the new heart inside the body of the patient and connects the large blood vessels entering and leaving the heart.

In uncomplicated surgeries the recipient of a donor heart can leave the hospital after about one to two weeks of stay at the hospital.

Care after surgery

After a heart transplant a patient is normally observed for any signs of rejection. This is a phenomenon where the recipient's body rejects the donor heart thinking it is a foreign object and mounts an immune response against it. It is for this very reason that an organ recipient is given drugs to suppress their immune system, making them susceptible to a varied number of opportunistic infections. It is important that the patient keep the area of the surgery and sutures clean and dry until it heals. He/she must visit the doctor regularly for proper follow ups, that may involve X-rays, blood tests and in some cases a biopsy to check for the health of the tissues around the heart.

A patient must visit their doctor if he/she experiences pain or swelling around the site of surgery, fever, breathlessness or any other significant discomfort.

Eventually, one may return to their normal life gradually and can go back to doing all the activities they enjoy as and when their body permits. (Read: Hundreds die in India for lack of organs)

How is a donor selected?

Receiving an organ is not as easy as donating one. In order for a patient to accept a donor organ, the donor will have to go through the following tests:

1. Blood Type Testing: This test establishes one'sABO blood group. There are four blood groups A, B, AB, and O. Since everyone has an inherent blood group, this is a basic test to avoid any adverse reactions due to blood group mismatches.

2. Human Leukocyte Antigens (HLA): The second test, which is a blood test for human leukocyte antigens (HLA), is also called tissue typing.

3. Crossmatch: We all have antibodies that are produced in order to protect us from infections and illness. In this test, the pathologist will test if your body already has antibodies to the donor kidney; if it does, the recipient's body will destroy the kidney.

4. Serology: Blood testing is conducted for potentially transmissible diseases, such as human immunodeficiency virus (HIV), hepatitis and cytomegalovirus (CMV).

Who can donate?

One way to donate is by having your driving licenses double up as donor cards. All you need to do is sign up with an NGO that gives you a donor card. There are various organizations like MOHAN (Multiple Organ Harvesting Aid Network) and the ZTCC, Mumbai (Zonal Transplant Coordination Centre) that you can register with and who are working to increase awareness among the common man. This card states the organ(s) you are willing to donate and what your blood group is.

Read more about causes, symptoms, diagnosis and treatment of heart disease.

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