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Heart TransplantsHeart Transplantation(Information for people who have had, or are waiting for, a heart transplant, and for their families and friends) (Information extracted from - British Heart Foundation – Heart Information Series Number 13) The first heart transplant was carried out in South Africa in 1967. In the UK, transplants are now carried out in six centres around the country – Harefield Hospital in London, Papworth near Cambridge, the Queen Elizabeth Hospital in Birmingham, Wythenshawe Hospital in Manchester, the Freeman Hospital in Newcastle, and the Royal Infirmary in Glasgow. Transplants for children are carried out at Great Ormond Street, in London and also in Harefield and Newcastle. Between 250 and 350 heart transplants are carried out in the UK each year. The number of transplants is limited by the number of donor hearts available. Most heart transplants are carried out on people with severe heart failure. The cause of the heart failure is usually coronary heart disease, or cardiomyopathy (a disease of the heart muscle). However not everyone who has severe heart failure is suitable for a transplant. And the number of transplants is still limited by the lack of available donors. In a very small number of cases, transplants are carried out on people who have abnormalities of the heart. (Congenital means from birth) If you have severe heart failure you are probably under the care of a cardiologist at a district general hospital or a teaching hospital. The cardiologist will try the full range of conventional medicines for heart failure before considering referring you to a ‘transplant centre’. The cardiologist will refer you to one of the six centres in the UK for a ‘transplant assessment’. Patients are usually referred to the nearest centre, unless the cardiologist has a long-standing connection with a more distant centre If you are referred for a heart transplant, you will need to have a ‘transplant assessment’. This involves a range of tests and assessments to make sure that a transplant is the best option for you. You will need to go into hospital for about three to five days to have the assessment. Some people may need to stay longer, or back afterwards for further tests. Some of the tests that may be carried out are:
You may already have had many of these tests in the past. The transplant assessment also gives you and your family the chance to meet members of the transplant team, and to as any questions. The team includes the surgeon, specialist transplant nurse, physiotherapists and psychologists; you may also have the chance to talk to other people who have had a transplant. Having a transplant carries significant risks and the transplant team needs to make sure that the benefits of the transplant outweigh the risks for each person. After the assessment, the staff at the assessment centre will decide whether you need a transplant and whether you are suitable for this form of treatment. They may decide one of the following:
Waiting for a transplant Once you are on the waiting list, the right heart for you might come along in a few days, or it may take many months or even years. For more information on waiting times ask at your transplant centre When you are on a waiting list it is important that you can be contacted at short notice. The transplant centre may give you a beeper or radio bleeper The doctor who referred you to the transplant centre will be responsible for your care during this waiting time. If your condition changes or if you need to start a new treatment, your doctor will tell the transplant team. If your condition changes, you may need to have another assessment to make sure that you are still suitable for a transplant Most transplant centres will want to make sure that, before they do the transplant, you have been treated for any medical problems, especially infections. They will ask you to visit a dentist, to make sure that you don’t have any mouth infection which could spread to your new heart Some people on the transplant list will be too ill to leave hospital and will have to stay in hospital until the transplant has been done. Doctors often give some priority to these patients, who are clearly in much more urgent need of the transplant. Getting the call for a transplant The transplant centre will contact you when they find a donor heart which they think is suitable. They will check that you have no new medical problems and will ask you to go to the centre. It is important to remember the following:
In the meantime, a separate surgical team will be examining the donor heart. Donor hearts may come from anywhere within the UK or, occasionally, from other countries in Western Europe. A period of four to five hours between removing the heart from a donor and transplanting the heart and restoring the blood supply in the person receiving it is acceptable. However, your team will try to reduce this time as much as possible. Hearts coming from some distance are often brought by air You will not be given the anaesthetic for the operation until the surgical team has confirmed that the donor heart is suitable and in good condition. Most transplants are performed at night as this is when most donor hearts become available. The operation takes between three and five hours After the operation After the operation, you will be moved to the intensive care unit, just as you would be after routine heart surgery You will have a wound across your breastbone, as the surgeon has to cut the breastbone to gain access to your chest. You will have chest drains and other tubes will be attached to veins in your arm and neck, to pass fluid and blood into your circulation. You will be sedated and continue breathing with the help of a ventilator machine until you are able to breathe for yourself. Many patients wake the following morning, others may take a little longer. If all is well you will be moved out of the intensive care unit as soon as you are in a stable condition. You may be moved to a high-dependency or ‘step down’ ward. Some transplant patients are nursed in special areas but often these will be on the same ward as patients who have had routine surgery on the heart and chest Life after a transplant Many heart transplant patients leave hospital two or three weeks after the operation. For the first month or two after the operation, you will probably need to stay very close to the transplant centre, after this you will need to go for weekly appointments at the outpatients’ clinic. Even years after a transplant, many people have four outpatients’ appointments a year at the transplant centre Recovery from the operation is as fast as for other forms of heart surgery, except that transplant patients were obviously weaker before the operation. You will be encouraged to take part in a rehabilitation programme, this includes visits to the gym and supervised exercise. The rehabilitation programme also offers advice about how to have a healthier lifestyle, and emotional support for you and your family In the first six weeks after your transplant you need to avoid doing any heavy lifting, pushing and pulling. You will be encouraged to build up your level of activity gradually, it is also important that you eat a healthy, balanced diet For those people fortunate enough to have a transplant, the long term outlook is now very good indeed, with quality of life vastly improved. It is important to remember that the heart is no more than a pump and that a transplant does not change your personality or behaviour You will need to make a life long commitment to keeping yourself and your new heart healthy. Taking your drugs and keeping to the follow-up programme are essential for the success of your transplant You are here: Home >> Articles >> Heart Transplants |
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