Your heart beats more than 100,000 times a day. In just one minute, it pumps more than five liters of blood throughout your body. But unlike skin and bones, the heart has a limited ability to repair itself.
So if the organ is severely damaged,
there is often only one medical solution: replacing it. Today, approximately 3,500 heart transplants are performed each year in a complex and intricate procedure with no room for error.
The process begins with screening potential recipients to ensure they are healthy enough for this necessary operation.
Doctors are particularly concerned about identifying immunocompromising diseases or other conditions that may compromise a patient's chances of survival.
The next step is to match a qualified recipient with a heart donor.
Donors are often comatose patients with no chance of resuscitation or victims of a fatal event who still have healthy hearts.
In both cases, these patients need to be registered as organ donors or their families need to give consent. And even when a heart is available, surgeons can't match just any donor with a recipient.
The recipient's immune system will see the transplanted heart as a foreign organism that must be attacked. So doctors need to match recipients with donors who share their blood type and have the same antigens. If a match can be made, surgery can begin.
Once the donor's heart is confirmed to be healthy,
the organ is immersed in an ice slush and injected with a cardiac arrest solution. These treatments stop the heart from pumping to ensure that it can be removed cleanly.
The surgeon then immerses the organ in a cold saline and preservation solution. This is when the clock starts. Cut off from the blood supply, the heart cells begin to suffer from the lack of oxygen.
The organ will only be viable outside the body for a few hours, so it needs to reach its recipient as soon as possible. After the heart is delivered, the recipient is placed under general anesthesia.
The surgeon makes an incision down the length of the chest, cutting the breastbone to separate the rib cage and expose the heart. To keep blood flowing while removing the damaged organ, surgeons use a cardiopulmonary bypass machine.
It takes over the work of the heart, generating enough force to propel blood through the circulatory system of the patient. After the old heart is removed, the surgeon begins to sew the donor heart back into place.
This is an incredibly precise process,
where every blood vessel and artery must be carefully ligated to avoid leakage. The procedure can last several hours, possibly longer if there is scar tissue from previous surgeries.
After that ends, the bypass machine is turned off and blood is allowed to flow into the aorta. Doctors carefully monitor the new heart to make sure it's beating on its own before sewing it back up to the recipient.
Even after the procedure is complete,
there is still work to be done. Surgeons are unable to connect the heart directly to the recipient's nervous system, and it can take years for the body to fully regenerate the new organ.
During this period, the transplanted organ has a higher resting heart rate and risk of stroke, making exercise difficult and dangerous.
And because it's incredibly rare to find a perfect match between donor and recipient, the immune system will also have some reaction to the new heart.
Immunosuppressive drugs can help manage the risk of rejection, but they also leave patients open to serious infections. Balancing these two concerns requires constant monitoring and evaluation.
Despite these challenges,
approximately 70% of heart transplant recipients survive at least five years after the operation, and only 20% survive for another 20 years. So when this procedure is successful, it is truly life-saving.
Unfortunately, people in developing countries are often unable to access this surgery, and many viable hearts cannot be donated due to legal and regulatory issues. Thousands remain on waiting lists, and many never find a suitable donor.
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