To determine eligibility for heart transplantation, the Heart Transplant team consults with the referring cardiologist and reviews medical records to determine if the patient meets the necessary criteria. Medical tests are then conducted to measure heart and other major organ function and to rule out any existing conditions that could hinder a successful surgery and recovery. A psychosocial evaluation is performed by a social worker to explore existing support systems and identify any concerns that might negatively impact the transplant process. All potential transplant patients may be randomly tested for alcohol or illicit drug use.
The Heart Transplant Team reviews test results and makes a collective decision regarding the candidacy for transplant. The decision is then shared with the patient, the family, and the referring physician.
Once a patient is added to the national heart transplant waiting list, the length of time before transplant depends on numerous factors including the patient's medical status, blood type, and body size. Waiting time for a donor heart can range from a matter of days to years. The average wait for heart transplantation at Henry Ford Hospital is shorter than the national average.
During Transplantation
Heart transplantation is one of medicine's most remarkable procedures. One team of surgeons opens the recipient's chest in the manner of any open-heart surgery. The patient is connected to artificial heart and lung equipment that keeps the blood circulating and the lungs working during the operation. Then the patient's diseased heart is surgically removed.
Meanwhile, at the donor's hospital (which may be many miles away), other surgeons remove the donor's heart and store it in a cold chemical solution to keep the tissue healthy. The donor heart is then brought as quickly as possible to the recipient's bedside, often by helicopter. Once the donor heart is delivered to the operating room, surgeons sew the heart into place and connect it with the recipient's blood vessels. As blood begins to flow, the heart warms up and begins to beat, sometimes with the aid of an electrical shock. The connections are checked for leaks. If all is well, the heart-lung machine is removed.
The heart transplant operation takes anywhere from two to six hours. The more previous operations the patient has had, the longer the procedure is likely to take.
Patients are cared for by specialized nurses in the intensive coronary care unit. The only discomfort would be around the surgical incision and effective pain medication is provided for patient comfort.
The hospital stay is usually two weeks following heart transplant surgery. New heart recipients begin cardiac rehabilitation while in the hospital and continue on an outpatient basis.
After Transplantation
Heart transplant patients are advised to take three months before returning to work. Once patients leave the hospital, regular follow-up checks with the physician will occur as well as ongoing cardiac rehabilitation. Henry Ford's cardiac rehabilitation program, available at several sites around metropolitan Detroit, is taught by staff members who are trained in exercise physiology, nutrition, and stress management. Staff members work hand-in-hand with the patient's physician to carefully tailor the program to the needs of each patient. No one is asked to do more than what is medically appropriate. Studies show that cardiac rehabilitation, when its principles are followed carefully over a period of years, substantially reduces the risk of death from heart disease. Patients also report better general health and fitness, more energy, and higher levels of physical activity.
The recipient of a heart transplant has a wonderful second chance at life. In many cases, one's quality of life improves dramatically. It is important for heart transplant patients to take care of the new heart by strict compliance with doctors' orders regarding medication, diet, and exercise. Otherwise, the second chance may be quickly wasted.
A low-fat, low-salt diet is recommended for heart transplant patients. Cardiac rehabilitation is strongly recommended after the transplant. Sexual activity may usually resume four to six weeks after transplant. Anti-rejection drugs pose some risk to fetuses, and thus women transplant patients are advised to seek their doctor's advice and care before becoming pregnant.
