Facts about … heart and heart/lung transplants - Pamphlet

Pamphlet by: U.S. Department of Health and Human Services, Sept, 1990

IN THE TWO DECADES SINCE THE PERFORMANCE of the first human heart transplant in December 1967, the procedure has changed from an experimental operation to an established treatment for advanced heart disease. Approximately 1,600 heart transplants are performed each year in the United States.

Since 1981, combined heart and lung transplants have been used to treat patients with conditions that severely damage both these organs. As of 1990, about 800 people worldwide have received heart/lung transplants.

In 1983, a major barrier to the success of transplantation--rejection of the donor organ by the patient--was overcome. The drug cyclosporine was introduced to suppress rejection of a donor heart or heart/lung by the patient's body. Cyclosporine and other medications to control rejection have significantly improved the survival of transplant patients. About 80 percent of heart tranplant patients survive 1 year or more. About 60 percent of heart/lung transplants live at least 1 year after surgery. Research is under way to develop even better ways to control transplant rejection and improve survival.

Organ availability is the second barrier to increasing the number of successful transplantations. Efforts by hospitals and organizations nationwide aim to increase public awareness of this problem and improve organ distribution.

What happens during a heart or heart/lung transplant?

A transplant is the replacement of a patient's diseased heart or heart and lungs with a normal organ(s) from someone who has died, called a donor. The donor's organ(s) is completely removed and quickly transported to the patient, who may be located across the country. Organs are cooled and kept in a special solution while being taken to the patient.

During the operation, the patient is placed on a heart/lung machine. This machine allows surgeons to bypass the blood flow to the heart and lungs. The machine pumps the blood throughout the rest of the body, removing carbon dioxide (a waste product) and replacing it with oxygen needed by body tissues. Doctors remove the patient's heart except for the back walls of the atria, the heart's upper chambers. The backs of the atria on the new heart are opened and the heart is sewn into place. A similar process is followed in heart/lung transplants, except doctors remove the heart and lungs as a unit from the donor; the new lungs are attached first, followed by the heart.

Surgeons then connect the blood vessels and allow blood to flow through the heart and lungs. As the heart warms up, it begins beating. Sometimes, surgeons must start the heart with an electrical shock. Surgeons check all the connected blood vessels and heart chambers for leaks before removing the patient from the heart/lung machine.

Patients are usually up and around a few days after surgery, and if there are no signs of the body immediately rejecting the organ(s), patients are allowed to go home within 2 weeks.

Why are transplant done?

A transplant is considered when the heart is failing and does not respond to all other therapies, but health is otherwise good. The leading reasons why people receive heart transplants are:

* Cardiomyopathy, a weakening of the heart muscle.

* Severe coronary artery disease, in which the heart's blood vessels become blocked and the heart muscle is damaged.

* Birth defects of the heart.

Heart/lung transplants are performed on patients who will die from end-stage lung disease that also involves the heart. Alternative therapies for these patients have been tried or considered. Leading reasons people receive heart/lung transplants are:

* Severe pulmonary hypertension--a large increase in blood pressure in the vessels of the lungs that limits blood flow and delivery of oxygen to the rest of the body.

* A birth defect of the heart that results in Eisenmenger's complex, which is acquired pulmonary hypertension.

Who can have a transplant?

Patients under age 60 are the most likely heart transplant candidates. Patients under age 45 are generally accepted for heart/lung transplants. In both cases, patients must be suffering from end-stage disease and be in good health otherwise. The doctor, patient, and family must address the following four basic questions to determine whether a transplant should be considered:

* Have all other therapies been tried or excluded?

* Is the patient likely to die without the transplant?

* Is the person in generally good health other than the heart or heart and lung disease?

* Can the patient adhere to the lifestyle changes--including complex drug treatments and frequent examinations--required after a transplant?

Patients who do not meet the above considerations or who have additional problems--other severe diseases, active infections, or severe obesity--are not good candidates for a transplant.

How are donors found?

Donors are individuals who are brain dead, meaning that the brain shows no signs of life while the person's body is being kept alive by a machine. Donors have often died as a result of an automobile accident, a stroke, a gunshot wound, suicide, or a severe head injury. Most hearts come from those who died under the age of 45. Donor organs are located through the United Network for Organ Sharing (UNOS).