At the center of the body’s circulation is a pump station that moves blood from the lung to all the vital organs.
This pump station activity is what the heart carries out every minute, every second of our lives. The heart has become the symbol of life and love in many cultures. The heart ensures a constant supply of oxygen and nutrients for all the cells of the various tissues in the entire body. Some of the heart diseases mentioned in other chapters of the Net Health Book can lead to a condition of no return.
Such conditions are repeated heart attacks, end stage congestive heart failure or myocarditis where the only way to save that person’s life is to opt for a heart transplant. This is an emotional topic as it implies that another person had to give up a life. If you are very sensitive, you may not want to read the remainder of this outline.
The history of heart transplantation goes back to Dr. Christiaan Barnard, the South African heart surgeon who performed the first human heart transplant in 1967 at the Groote Schuur Hospital, Cape Town. Unfortunately, at that time the science of transplantation immunology was still in its infancy. Today extensive tests are performed on the blood cells of the donor person who usually is a traffic accident victim in a terminal coma. HLA typing of the white blood cells is done with a battery of antisera. The recipient’s white blood cells are also mapped and if there is a close match in most such cell surface antigens, then the signal is given by the transplantation immunologist for the transplant surgeon to proceed with the surgery.
Following the successful transplant a rigid protocol is followed, similar to what NASA would do for astronauts, where the cardiologist is scrutinizing the success of the transplant surgery. Ejection fractures are measured and periodic heart muscle biopsies are performed by the specialist to monitor the pump function of the heart and to monitor for early signs of rejection of the heart by the host’s immune system. Today we have much more specific immunosuppressants than in the early days of heart transplantation. By monitoring the immune system with blood test and cardiac biopsies and by titrating the immunosuppressive medication, it has become possible to have long-term survival of heart transplant patients. However, the patient needs to discipline him/herself to continue to be followed up by the transplant team. It is in the best interest of the patient as this is the life line and the alternative is death.
The reason I went into some detail about this is that patients need to know what they are in for with a heart transplant. It may also motivate some readers to rethink their habits. If you are smoking, it would be a lot easier to quit now than to try to fix the damage later. Keep in mind that only a small percentage ever make it on the waiting list for a heart transplant because of the complexity of the perfect immunological fit that is required, the insecurity of the supply, where we depend on a donor heart from a clinically dead (usually brain dead) traffic or suicide victim. Cherish your own heart and hope that you will never need a heart transplant!
Having said all this, it is a blessing that the heart transplant technology is available and countless patients and their families throughout the world owe their new found happiness to this heroic part of medicine. It is one of the positive modern sagas where computer technology, airplane traffic, immunology and new surgical techniques have lead to a victory over the barriers of negative bias, racial and social prejudice, and where collaboration among people of different walks of life has risen to a common goal and has achieved miracles. This process is constantly monitored by ethics committees throughout the world to guard against abuse by political powers in some less regulated countries who may want to take advantage of the shortage of donor hearts (Ref. 2, p.615).
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapters 197, 202, 205 and 207.
2. Braunwald: Heart Disease: A Textbook of Cardiovascular Medicine, 6th ed., 2001, W. B. Saunders Co.
3. D C Bauer: Audio-Digest Family Practice Vol. 49, Iss. 09, March 2, 2001.
4. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
5. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier