Heart Transplant Treatment : Procedure, Costs & Hospitals in India

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  • 11 Mar, 2019

The heart is the pumping plant of the human body that pumps the blood throughout the body. Its circulatory system supplies oxygen along with other nutrients to the tissues and also removes carbon dioxide with other wastes.

To simply put it, the heart helps in keeping the body tissues active and alive by providing them with nutrition and oxygen, or else they will die. Thus, any issue with cardiovascular health needs to be given immense importance.

Heart diseases can range from mild to severe and in the situations where treatment and medication can’t cure the diseases and the heart stops functioning, a heart transplant is been carried out. So in order to develop an in-depth understanding of the heart transplant, let’s first know about a few of the important aspects.

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Embryology of the Heart

The human heart is about the size of a fist of the person with a weight of around 280 to 340 grams in men, and it is around 230 to 280 grams in women.

The human heart can be described as the muscular pump which is divided into four chambers along with the same number of valves which helps in preventing the backflow of the blood.

  • The upper chambers in the heart are called left and right atria,
  • The two at the bottom side are called ventricles.

The atria receive the blood from the different parts of the body and the ventricles have the work of pumping the blood back to the different body parts.

Though it is as small as your fist, the heart is powered enough to keep the blood flowing through nearly 60,000 miles of blood vessels connecting to organs, muscles, and tissues.

What is a Heartbeat?

There is a pacemaker cell present in the Sinoatrial node (SA Node) of the heart which rapidly produces electricity in the body by changing the electrical charge from negative to positive and then back again. This results in a heartbeat.

Pumping mechanism of heart

The circulation of the blood by the heart is done through two trails i.e. systematic circuit and the pulmonary circuit.

  • Pulmonary circuit: In this pathway, deoxygenated blood from the right ventricle goes in the lungs via the pulmonary artery and the oxygenated blood from the lungs travel back to the heart’s left atrium via pulmonary vein.
  • Systematic circuit: In this pathway, the body is supplied with the oxygenated blood via left ventricle where it first goes to the aorta and then is supplied to the entire body with the help of the capillaries and arteries. And then again the deoxygenated blood returns back to the heart and cycle continues.

What is the underlying cause for heart disease?

Since the heart is also a muscle which needs blood to revive, therefore when the blood is pumped to the entire body via aortic valve, two sets of arteries then supply the heart with oxygenated blood in order to feed the muscle.

Over time, increase in fat and cholesterol deposits causes plaques in the arteries. This blocks the arteries and restricts the blood flow. Such a condition may either result in a heart attack or it can damage any of the heart muscle.

There are two different terms i.e. heart attack and cardiac arrest, where cardiac arrest refers to the loss of the heart function suddenly due to the electrical disturbances in the heart rhythm. One of the causes of the cardiac arrest can be a heart attack but there can be other causes too.
For adults, there can be several causes for heart failure which can be as follows:

  • Coronary heart diseases
  • Conditions or the problems passed down in the heredity
  • Heart’s viral infection
  • Damaged muscles and the heart valves

Heart failure and its diagnoses:

A situation where the heart is unable to do the pumping action and is not able to fulfill the body requirement, then it is called heart failure. There can be two scenarios:

  • The heart failure is sudden. Its onset is known as acute heart failure.
  • The person is unaware about the worsening condition of his heart. This is known as chronic heart failure.

For diagnosing the wellbeing of the heart, there are two tests which are to be performed,

  • An echocardiogram which measures the ejection fraction that is a measure of how well the contraction function of the heart is going on
  • A blood test called the NT-pro BNP. This is a hormonal test and is done to check the level of the hormone, as it increases in the blood as a sign of the heart failure.

Depending on the results of the diagnostic tests and the severity of the condition, the physician may recommend many changes to lifestyle, food intake, exercises, and medication. However, when everything fails, they look at heart transplant surgery to save the patient’s life.

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Heart Transplant Surgery, at last resort

A heart transplant surgery is the last resort for patients suffering from coronary heart diseases. This is an option when all the treatments and the medication has failed to cure the heart problem.

The patients who are advised for the heart transplant have already tried all the other possible and less complicated treatments and are also hospitalised many times before.

Who are suitable for the heart transplant surgery?

Before the doctor suggests for the surgery, he checks on a few points which confirms the suitability of the heart transplant surgery for the patients. Some of the criteria’s that are to be fulfilled are:

  • Age of the patient should be less than 69 years.
  • The patient should have diagnosed with the last stage heart problem like severe heart failure, pulmonary heart tension etc.
  • There should be a risk of the mortality to the patient within a year if he does not undergo a heart transplant.
  • The patient should not be suffering from other major diseases other than heart diseases like cancer or another organ failure.
  • It is necessary that the patient should be in sound mental health for understanding all the related concerns of heart transplant surgery and also is motivated enough to post-operative rehabilitation.
  • The patient should be in the category of obese as per medical norms.
  • There should be a proper and adequate and proper backup plan concerning the finances as well as the social support with the post-rehab activities as well as care.

Expectations to be kept before opting for the heart transplant surgery

Waiting list
The patients who pass the eligibility criteria for the heart transplant get themselves enlisted. This list is a part of the national allocation system for allocating the donor organs. It is managed by the organ procurement and transplantation network.

There are certain criteria to fix the priorities of the patients such as the medical urgency of the patient, location of the patient, available number of organs etc.

Also, organs are transplanted after matching the blood type as well as the size of the recipient and the donor.

Donor’s heart
Guidelines for the selection of the donor’s heart comprises of a key legal requirement. The donor has to be announced brain dead and all legal consent forms must be duly filled up.

Also, the donor should be less than 65 years old and have no heart disease history and not diagnosed with HIV.

Waiting time
Unfortunately, the waiting list for the heart transplant is very long, which is often increased to the six months. In the UK, around 3000 people are present on the list on any given day and there are around 2000 organ donors present.

The waiting list is been prepared on the basis of the priority status which is as follows:

  • 1a = highest priority, consist of those people who are in the ICU in order to provide support to their heart while waiting for their turn for the heart transplant.
  • 1b = medium priority, consist of the people who are at home but needs the IV medications along with the other treatments in order to keep their heart in the working condition.
  • 2 = less urgent, consist of the cluster of the people who are in the stable condition at their home and are waiting for their turn for heart transplantation.

There are few more factors that affect the lead time or waiting time like the blood type, location of the patient, height and weight of the patient etc. On top of everything, there might be a shortage of donors.

Ongoing medical treatment
Patients who are listed at the waiting list for getting the donor’s heart, have to be under an ongoing medical treatment. This helps to keep the condition stable until the donor is available.

The patients may have to go through medical treatment either for heart failure or for the other medical conditions. Some of the ongoing treatments can be for the arrhythmias, or the doctors might place the ICDs i.e. implantable cardioverter defibrillators before taking them in the surgery.

One more possible treatment that can be given to the patients are ventricular assist devices. Patients may also register themselves in cardiac rehabilitation. This will help them in being mentally strong so that they are able to cope up with their heart problems.

Be in touch during the lead time with the Transplant Center
Patients who are waiting for their donors must remain in contact with the transplant centres. This is because it is necessary to transplant the heart of the donor within the 4 hours after it is removed from the donor. At some of the centres, patients are provided with the pager facility which makes it easy for the centres to notify the patients anytime.

Heart Transplant Procedure

Once the donor is available, the heart is been removed from his body by the surgeon and then is stored in the cool place in a precised solution. Then the surgeons and the transplant centers try on getting the transplant surgery done as soon as possible.

At the time of surgery, a heart-lung machine is been attached to the patients which help in maintain the circulation of the oxygen in the body along with the nutrients via blood even though the heart is under treatment.

After that the heart is removed by surgeons, leaving behind the back walls of the atria i.e. the upper chambers of the heart. The back of the new heart is then opened at the upper chamber of the left side which is then connected to the left behind a wall of the patient’s heart.
Also on the right side, two large veins are connected in an independent manner. Surgeons then reconnect all the vessels which allow the flow of blood in the patient’s body in the natural mechanism form heart and lungs.

As soon as heart warms up, it again starts beating. Before removing the heart and lungs machine from the patient’s body, the surgeon makes sure that there are no leakages. The complete procedure takes around 4 to 10 hours and is a complex process.

Expectations to be kept after the transplant

Staying in the hospital
The patient needs to be in the hospital for about 1 to 2 weeks and then is under the scrutiny of the transplant team for about 3 months.
Scrutiny consists of the various blood test, EKGs, echocardiograms etc. It helps assess if the heart is functioning as expected and compatible with the recipient organs and body.

Watching for signs of rejection
After the heart transplant, the body will take the heart as a foreign object, therefore the immune system might attack the heart. Therefore, it is important to look for the signs of rejection of the new organ

This monitoring is to be done by both, i.e. the patient and the transplant team. Some of the symptoms are shortness of breath, tiredness, reduction in urination, weight gain etc.

Preventing rejection
You will be needed to take the proper medication in order to reduce the chances of the rejection of the new heart. These medicines are called immuno-suppressants.

Managing the medications along with their side effects

It becomes very vital for the patient to maintain his medication routine after the surgery, as it helps in boosting up the recovery. This is also important because some of the medicines may have side effects which can be very dangerous so make sure you are taking the medications as prescribed by the doctors.

Preventing the infection
There is a possibility of the infection after the transplant is done, therefore be aware regarding any signs which might indicate towards the infection which may include fever, sore throat, flu-like symptoms, cold sores etc.

Pregnancy
There are many cases where the pregnancies happened after the transplant but then the lady has to undergo special care and should be made sure of the doctor consultation before the pregnancy planning.

Emotional issues along with the mental support
There is a high possibility of taking the stress, getting anxious before and after the surgery which is quite normal for the person who has to go through such a big surgery. Therefore, it is advisable to consult the doctor or the professional regarding the same so as to enhance and boost up your confidence as well as morale.

Risks concerning the heart transplant

Failure of the donor’s heart
There is a risk that the new heart may also fail after some time reason being the same as the old heart. Failure can also be the result of the rejection of the new organ from the body.

Primary graft dysfunction
One of the reason of the death within the first 30 days of the transplant is the primary graft dysfunction, which means the heat of the donors fails in the body of patients and its operation failed.

Rejection of the donor’s heart
One of the leading causes of death in the primary years after the transplant is the rejection of the new organ by the immune system of the body. During the first year after the rejection, the patient goes through three episodes of rejection which is most likely to happen within the 6 months of the heart transplant surgery.

Complications from medicines
Patients are advised and prescribed by the doctors to take the medicines so as to resist the immune system from attacking the new organ, but these medicines have some severe and adverse side effects.

Infection
When the immune system of the body is suppressed, the gets more vulnerable and prone to the infection, which is also a cause of the hospital transplant patients getting admitted in the hospital and they are also prone to high level of cancer risk.

Cost of treatment across various countries

In India, the heart transplant treatment cost starts from $38,000 which is comparatively very less as compared to the other countries. In the US, the entire procedure costs around $1,40,000.

With international quality treatment and healthcare, residents from the US, UK, Europe, and South Africa are increasingly looking at medical tourism to undergo complex procedures like heart transplant successfully. They utilize the global infrastructure and physicians’ credibility to deliver excellent patient outcomes.

Conclusion

If patients choose India for the heart transplant surgery, then the total cost will be less even after including all the expenses i.e. travelling cost, accommodation cost, food etc. The top-rated medical facilities in India ensure that patients get high-quality medical treatment at a fraction of the cost in the Western nations.

Get in touch with a reliable medical tourism agency to know your options and take the right first step towards affordable yet superior healthcare.

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