Heart Transplant: Procedure, Recovery, Cost, Risk & Complication

A heart transplant is a surgical procedure where a failing or diseased heart is replaced with a healthier heart. This treatment is usually recommended to patients whose conditions have failed to show any improvement even after medications and other surgeries. In most cases, a brain-dead patient is considered as a donor for a heart transplant.

Before a heart transplant, an assessment will be done for checking whether you are suitable for a heart transplant. You would be then put in the waiting list, where you have to wait till the time you get a suitable donor. It may take a few days to get a donor, but in some cases it may even take months or years.

A patient may need a heart transplant in the following conditions:

• Coronary artery disease
• Cardiomyopathy, a condition where your heart muscles get weakened
• Heart valve disease
• Congenital heart defect (problem in the structure of the heart from birth)
• Abnormal rhythms of the heart that keep recurring and cannot be controlled by medications
• Amyloidosis (deposit of abnormal proteins in organs and body tissues)
• A previous heart transplant that has failed

Pre Procedure

The pre-procedure guidelines before undergoing a heart transplant are:

• First and foremost, you will be evaluated to check for certain conditions like if you are healthy enough for undergoing the surgery and the lifelong medications that you need to take post-surgery.
• While you will be put on the waiting list for a suitable heart donor, make sure that you are nearby as you can get a call any moment. You will be informed once the donor heart is available and you need to come to the hospital immediately.
• Timing is an important factor here as the donor heart can survive only for 4-6 hours after taken out from the body.
• Once you arrive at the hospital, you will be administered the pre-operative medicines and prepared for the surgery. The chest area will be shaved, and rubbed with an antiseptic lotion. The IV line will be started, for administering the anaesthesia.

During Procedure

Heart transplant surgery is basically an open heart surgery that may take several hours. General anaesthesia will be administered in this procedure. You will be connected with a heart-lung bypass machine to ensure there is proper blood flow during the whole operation. The surgeon first makes an incision in the chest, and opens the rib cage to get access to your heart. The diseased heart is then removed and the donor heart will be placed in its place. The surgeon will then attach the major blood vessels to the donor heart. Once the blood flow gets restored, the heart starts beating again. In some cases, an electric shock needs to be given for the heart to start beating properly.

Post Procedure

Post surgery, you will be shifted to the ICU where you have to stay for a few days. During this time, you will be closely monitored by the doctors to see how the donor heart is functioning, or watch out for any symptoms of rejection like fever, fatigue, shortness of breath, etc. You will be given medications for your pain. There would also be drainage tubes fitted so that the excess fluid can be removed from the chest cavity. Generally, you will have to spend 1-2 weeks at the hospital, although it depends on your rate of recovery.

There will be several follow-up tests and appointments with the doctor in the initial months. In the first few months after a heart transplant, you will also have to undergo biopsy test at regular intervals so that the doctor can analyse if your body is rejecting the donor heart or not.

The possible risks or complications of a heart transplant may include:

• Bleeding or infection from the incision site
• Formation of blood clots
• A sudden stroke
• Rejection of the donor heart by your body
• Problems in the coronary arteries, where the walls of the arteries may thicken or harden, leading to heart failure or irregular heart rhythms
• The medications that you have to take for the rest of your life can lead to health issues like high cholesterol, diabetes, high blood pressure, kidney damage or osteoporosis. The medicines can also increase your risk of cancer and infection, as it decreases the ability of your body to treat infections.

There will be several adjustments that you will need to make in your lifestyle after a heart transplant. There will be some medicines that you have to take for the rest of your life, which may make you more vulnerable to infection and develop health conditions like high cholesterol, high blood pressure or diabetes. Gradually, the dosage might decrease depending on your condition. Ensure that all the medications are taken regularly. Eating a healthy diet, exercising regularly and avoiding tobacco products are the basic changes that needs to be made in your daily life. Your doctor may also suggest a cardiac rehabilitation programme for you, involving exercising and diet guidelines to recover better after a transplant.

The cost of a heart transplant would be approximately Rs. 15 lakhs – Rs. 20 lakhs.