Heart Transplant is a delicate life saving surgery that requires a lot of precision and expertise. While annually around 4000 to 5000 Indian patients would require a heart transplant, a beacon of hope for patients with end stage heart failure (an intractable state of heart failure), it eludes the reach of many a needy patient.

So far, only 43 heart transplants have been conducted across the country. The figures are scanty, when pitted against 2,057 heart transplants performed in the US in year 2003. Worldwide, approximately a little over 3000 heart transplants are conducted, annually.

So if your doctor prescribes you one, do not panic, and read ahead and get your doubts and facts right.

Believe it or not, heart transplantation is a relatively simple operation for a cardiac surgeon. In fact, the procedure actually consists of three operations.

The first operation is harvesting the heart from the donor. The donor is usually an unfortunate person who has suffered irreversible brain injury, called "brain death".

The second operation is removing the recipient's damaged heart. Removing the damaged heart may be very easy or very difficult, depending on whether the recipient has had previous heart surgery (as is often the case). If there has been previous surgery, cutting through the scar tissue may prolong and complicate removal of the heart.

The third operation is probably the easiest; the implantation of the donor heart. Today, this operation basically involves the creation of only five lines of stitches, or "anastomoses". These suture lines connect the large blood vessels entering and leaving the heart. Remarkably, if there are no complications, most patients who have had a heart transplant are home about one week after the surgery.

Do you need a transplant?
Some patients with severe heart disease may benefit from transplantation. Your cardiologist or pulmonary medicine specialist may refer you to a transplant center for an evaluation. The purpose of the evaluation  is two-fold:
•    To determine the severity of your disease and whether there are any more conventional treatments
•    To determine whether you would be able to survive the transplant operation and have a good long-term result afterwards.

How will a transplant change my life?
A successful transplant will dramatically improve your symptoms of heart disease. Many transplant recipients can perform the same physical activities and enjoy the same quality of life as those without transplants. All transplant recipients, however, are committed to daily drug treatment and close medical supervision for the rest of their lives.

Evaluation
The transplant evaluation is very thorough. In addition to specific heart assessment, tests are performed to determine the function of all the major organ systems, screen for infectious diseases and cancer, and try and predict how well you and your family will cope with the rigors of the transplant regimen. Many of the tests, even the complex ones, are fairly standardized and can be performed in your local testing centers. Some tests may require you to be briefly admitted to a hospital. Typically, most of the evaluation can be completed within a week or two.

Availability of an Organ
When the transplant team in the hospital decides that a potential donor is suitable for one of the recipients, doctors contact the patient as soon as possible. Since it is not possible to predict when a suitable organ will become available and there is a limited amount of time to recover the organs successfully, it is very important that doctors are able to locate recipients quickly and get them into the hospital in a timely fashion.

Complications
One might ask, "Why is survival no better than it is after a heart transplant?" Good question. As part of our defense mechanism to fight off infection and even cancer, our bodies have an "immune system" to recognize and eliminate foreign tissues such as viruses and bacteria. Unfortunately, our immune system also attacks transplanted organs. This is what happens when organs are rejected; they are recognized as foreign by the body. Rejection can be controlled with powerful "immunosuppressive" medications. If there is not enough immune suppression the organ can reject acutely. Even when it seems that there is no active rejection, there may be more subtle chronic rejection that consists of a growth of tissue, something like scar tissue, which causes blockage of the blood vessels of the heart. The blockage of the vessels is the process that ultimately causes the transplanted heart to fail. It is this chronic rejection that is the major limiting factor for the long-term success of heart transplantation.

Unfortunately, immune suppression is a double-edged sword. While immune suppression blocks rejection, because it suppresses the immune system, transplant patients are more susceptible to infection and cancers of various types. Among older transplantation patients, as survival has improved, more patients are eventually dying from cancers.

Hospitalisation
This depends on your specific situation. Although patients can recover sufficiently after heart transplantation to be discharged within 10 days, it is more typical for patients to be hospitalized for two weeks or more.

Results
When all potential problems are considered, the results of transplantation are remarkably good. Keep in mind that heart failure is a very serious and life-threatening disease. In patients with severe forms of heart failure that require transplantation, the one year mortality rate (that is the percent of patients who die in within one year) is 80%. Overall, five year survival in patients with any form of heart failure is less than 50%. Compare these outcomes with cardiac transplant. After heart transplant, five year survival averages about 50%-60%. One year survival averages about 85%-90%.

Most patients are allowed to go home after they have recovered from the transplant surgery. Although hospitals do not have any specific requirement about staying close to the hospital during the initial period after transplantation, the frequency of follow-up visits and lab tests during this interval can be a problem for patients who live far away.

Post surgery pain?
Generally, most patients do not report a lot of pain after heart transplant surgery. The incision does cause pain or discomfort when you cough. Doctor’s will give you pain medication and specific instructions to lessen the pain.

Scars
The scar is down the center of the chest. It starts at the notch, or top of the sternal bone, just under your neck, and ends just past the end of the sternal bone. Initially the scar is more prominent. Over time, it will fade to a very light, thin line.
What medications will I take after the transplant surgery?
You will be on three main immunosuppressive, or anti-rejection, medications after your heart transplant. Along with the immunosuppressive medications you will need to take several medications that help protect your body from infection.

Getting back to routine
After heart transplantation, you can drive when your sternum, or breastbone, is fully healed. This takes about six weeks.You may return to work two to three months after the transplant surgery.It generally takes three to six months to fully recover from heart transplant surgery. However, age and previous medical problems may cause a longer recovery period.

Insurance Issues
Major hospitals have a financial counselor who will verify your insurance coverage. They will thab obtain authorization for your transplant and follow-up care.

*Image courtesy: © Thinkstock photos/ Getty Images

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