or cardiac transplantation
, is a surgical transplant
procedure performed on patients with end-stage heart failure
or severe coronary artery disease
. The most common procedure is to take a working heart
from a recently deceased organ donor
) and implant it into the patient. The patient's own heart may either be removed (orthotopic procedure
) or, less commonly, left in to support the donor heart (heterotopic procedure
). It is also possible to take a heart from another species (xenograft
), or implant a man-made artificial one
, although the outcome of these two procedures has been less successful in comparison to the far more commonly performed allografts
The first heart transplanted into a human occurred in 1964
at the University of Mississippi Medical Center
in Jackson, Mississippi when a team led by Dr. James Hardy transplanted a chimpanzee heart into a dying patient. The heart beat for 70 minutes before stopping. Dr. Hardy had performed the first human lung transplant
the previous year. The first human to human heart transplant was performed by Professor Christiaan Barnard
at Groote Schuur Hospital
in December 1967
. The patient was a Louis Washkansky
of Cape Town
, South Africa
, who lived for 18 days after the procedure before dying of pneumonia
. The donor was Denise Darvall
, who was rendered brain dead
in a car accident. The first successful United States heart transplant was done at Stanford University
by doctor Norman E. Shumway
in January, 1968. Subsequently, another transplant was done at St. Lukes hospital in Houston Texas by Denton Cooley
, M. D. in June 1968. The donor was a teenage suicide victim (who had had an aortic coarctation repaired as a young child, also by Dr. Cooley) and the recipient, Mr. Thomas, had terminal severe cardiomyopathy. He survived 8 months before dying of rejection of the transplanted heart. A series of five subsequent heart transplants were done that month by Dr. Cooley followed by a number of transplants in Houston that year before the program was canceled, leaving only Norman Shumway at Stanford University doing heart transplants and research on the rejection phenomenon. In 1984, at two years old, Elizabeth Craze
became the youngest surviving heart transplant patient.
At least the concept of heart transplantation dates back to at least 400 AD in China. The book of Liezi tells a story of Bian Que exchanging the hearts of two warriors to balance their personal characteristics.
In order for a patient to be recommended for a heart transplant they will generally have advanced, irreversible heart failure
with a severely limited life expectancy
. Other possible treatments for their condition, including medication, should have been considered prior to recommendation. Generally, the following causes of heart failure
can be treated with a heart transplant:
Some patients are less suitable for a heart transplant, especially if they suffer from other circulatory
conditions unrelated to the heart. The following conditions in a patient would increase the chances of complications
occurring during the operation:
A typical heart transplantation begins with a suitable donor heart being located from a recently deceased
or brain dead
donor. The transplant patient is contacted by a nurse
coordinator and instructed to attend the hospital in order to be evaluated for the operation and given pre-surgical medication. At the same time, the heart is removed from the donor and inspected by a team of surgeons to see if it is in a suitable condition to be transplanted. Occasionally it will be deemed unsuitable. This can often be a very distressing experience for an already emotionally unstable patient, and they will usually require emotional support before being sent home.
The patient must also undergo many emotional, psychological, and physical tests to make sure that they are in good mental health and will make good use of their new heart. The patient is also given immunosuppressant
medication so that their immune system will not reject the new heart.
Once the donor heart has passed its inspection, the patient is taken into the operating room
and given a general anesthetic
. Either an orthotopic
or a heterotopic
procedure is followed, depending on the condition of the patient and the donor heart.
The orthotopic procedure
begins with the surgeons performing a median sternotomy
to expose the mediastinum
. The pericardium
is opened, the great vessels
and the patient is attached to cardiopulmonary bypass
. The failing heart is removed by transecting the great vessels and a portion of the left atrium
. The pulmonary veins
are not transected; rather a circular portion of the left atrium containing the pulmonary veins is left in place. The donor heart is trimmed to fit onto the patients remaining left atrium and the great vessels are sutured
in place. The new heart is restarted, the patient is weaned from cardiopulmonary bypass and the chest cavity is closed.
In the heterotopic procedure
, the patient's own heart is not removed before implanting the donor heart. The new heart is positioned so that the chambers and blood vessels of both hearts can be connected to form what is effectively a 'double heart'. The procedure can give the patients original heart a chance to recover, and if the donor's heart happens to fail (eg. through rejection
), it may be removed, allowing the patients original heart to start working again. Heterotopic procedures are only used in cases where the donor heart is not strong enough to function by itself (due to either the patients body being considerably larger than the donor's, the donor having a weak heart, or the patient suffering from pulmonary hypertension
The patient is taken into ICU
to recover. When they wake up, they will be transferred to a special recovery unit in order to be rehabilitated
. How long they remain in hospital post-transplant depends on the patient's general health, how well the new heart is working, and their ability to look after their new heart. Doctors typically like the new recipients to leave hospitals soon after surgery because of the risk of infection in a hospital (typically 1 - 2 weeks without any complications). Once the patient is released, they will have to return to the hospital for regular check-ups and rehabilitation sessions. They may also require emotional support. The number of visits to the hospital will decrease over time, as the patient adjusts to their transplant. The patient will have to remain on lifetime immunosuppressant
medication to avoid the possibility of rejection
. Since the vagus nerve
is severed during the operation, the new heart will beat at around 100 bpm
until nerve regrowth
'Living organ' transplant
Doctors made medical history in February 2006
, at Bad Oeynhausen
Clinic for Thorax- and Cardiovascular Surgery, Germany
, when they successfully transplanted a 'beating heart' into a patient.
Normally a donor's heart is injected with potassium chloride
in order to stop it beating, before being removed from the donor's body and packed in ice in order to preserve it. The ice can usually keep the heart fresh for a maximum of four to six hours with proper preservation, depending on its starting condition. Rather than cooling the heart, this new procedure involves keeping it at body temperature
and hooking it up to a special machine called an Organ Care System
that allows it to continue beating with warm, oxygenated blood flowing through it. This can maintain the heart in a suitable condition for much longer than the traditional method.
The prognosis for heart transplant patients following the orthotopic procedure has greatly increased over the past 20 years, and as of Aug. 11, 2006, the survival rates were as follows.
- 1 year: 86.1% (males), 83.9% (females)
- 3 years: 78.3% (males), 74.9% (females)
- 5 years: 71.2% (males), 66.9% (females)
As of the end of 2007, Tony Huesman is the world's longest living heart transplant patient, having survived for 29 years with a transplanted heart. Huesman received a heart in 1978 at the age of 20 after viral pneumonia severely weakened his heart. The operation was performed at Stanford University under American heart transplant pioneer Dr. Norman Shumway, who continued to perform the operation in the U.S. after others abandoned it due to poor results.. Another noted heart transplant recipient, Kelly Perkins, climbs mountains around the world to promote positive awareness of organ donation. Perkins is the very first heart transplant recipient to climb to the peaks of Mt. Fuji, Mt. Kilimanjaro, the Matterhorn, Mt. Whitney, and Cajon de Arenales in Argentina in 2007, 12 years after her transplant surgery. Dwight Kroening is yet another noted recipient promoting positive awareness for organ donation. Twenty two years after his heart transplant, he is the first to finish an Ironman competition.