Heart Transplant

Most people who are considering heart transplantation can remember the news stories about early recipients. And while the technical know-how of a heart transplant procedure was impressive, the early results were not. Today, the stories have changed dramatically, Eighty to 90 percent of heart transplant recipients reach their first year anniversary and 60 to 70 percent celebrate their ten-year anniversary. The quality of life for the heart transplant recipient has improved as well, with about 90 percent returning to a very active lifestyle after surgery, with the "typical" patient regaining about 80 percent of their normal physical capacity. The difference over the past 30 years has been the development of a lifelong program of care for each patient, beginning before a decision in favor of a transplant is even made, and continuing throughout the transplant recipient's life. The Saint Francis Heart Transplant Program was developed in 1993 to bring this comprehensive, life-saving care to patients in the Tulsa region.

The Decision to Proceed

Heart transplantation is a treatment for what is called "end-stage" heart disease, meaning that without a heart transplant, your life is at risk because of your weakened or damaged heart. The urgency of surgical intervention, however, varies considerably. Some patients are able to continue living at home, and some patients require hospital care while waiting for a matching heart. A comprehensive evaluation, including medical tests, and psychological consultations is designed to help you and the transplant team determine if a heart transplant is the best option.

Some of the terms you will become familiar with as a patient or family member include:

Tissue and Blood Type, which determine the type of heart required for a "match"
Social Support System, which refers to the availability of friends and family through the waiting period, surgery, and follow-up care.
Immunosuppressant Therapy, which is the lifelong use of specific medications that help your body avoid rejection of the heart transplant.

The decision to proceed toward transplantation is based both on statistical information -- the percentages that tell how severely your life will be affected without a transplant -- and on personal feelings, as well as you and your family's understanding of, and commitment to, the demands of the transplant operation and also the lifelong compliance with self-monitoring and medications. A decision in favor of transplantation means entering into a partnership with the transplant team, with you and your family playing a vital role in treatment planning, communications and follow-up.

Waiting for Surgery

The waiting period varies for every transplant patient. "Status I" patients are usually hospitalized while waiting for surgery at the earliest possible time. "Status II" patients live at home while being followed very closely for any medical change. If you or a family member is Status II, there will be appointments scheduled at the Transplant Clinic every four to six weeks. These visits include an evaluation by the cardiologist and nurse transplant coordinator and an opportunity to discuss financial or home care issues with the social workers.

Every Status II patient is given a pager which should be carried at all times in the event a matching heart is identified. When a donor heart has been identified, the transplant coordinator will first attempt to reach you by telephone, then by pager because time is critical. Anytime you will be more than one to one-and-a-half hours away from the hospital, the transplant coordinator will need to be notified. When the call comes, you will be told where to go in the hospital. Because there is no way to know in advance when you will be called, it is advisable to keep a small suitcase packed beforehand.

After Heart Transplant Surgery

After your heart transplant surgery, you will be monitored continuously in the Cardiac Intensive Care Unit for the first 24-28 hours. A mechanical ventilator is used to ensure adequate breathing. Every body system is monitored electronically, including the heartbeat, the oxygen content in the circulating blood and pressures in the heart and blood vessels. Additional tubing is in place for continuous management of chest drainage, nasogastric suctioning and urinary elimination. Intravenous lines are used to administer medications and obtain blood samples for testing.

It is important for you and your family members to remember that all of this electronic equipment is automatically monitored by various alarm systems and that the sound of an alarm is usually just a redundant system for the nursing staff who will be evaluating your condition and the integrity of all body systems continuously.

You will be transferred to the Transplant Unit after the immediate postoperative recovery. After three to five days, it may be possible to proceed to the Cardiac Rehabilitation Unit, where your activity is gradually resumed. During your stay in Cardiac Rehab, you and family members will learn the essential care that will help you return to an active healthy life, including an exercise and diet program, blood pressure self-monitoring and emotional support to help reduce any anxieties or concerns.

You will most likely be discharged from the hospital one to two weeks after your surgery.

Our Lifelong Committment

Much of the care that has made heart transplants so successful over the past decade begins after the actual surgery. The primary goal is to prevent or minimize potential complications, while helping you achieve the highest possible quality of life. The Saint Francis Transplant Team defines the program as a lifelong commitment and works closely with you and your family, as well as with specialists across the country to provide the best possible care over the years to come.

Essential components of this post-transplant care include:

Immunosuppressant therapy. The primary problem any transplant recipient faces is organ or tissue rejections. Many new drugs have been developed to minimize the impact of the body's normal immune response to anything foreign. These "anti-rejection" drugs have some side-effects of their own, but the transplant team will work with you and your family to establish doses and schedules that cause the fewest possible problems while yielding the highest possible benefit. You will be asked to keep a medication diary and to bring it with you to each follow-up visit with the transplant team. It is important to notify your team members any time you are experiencing potential problems, including colds and flu.

Endomyocardial biopsies. Testing for organ rejection is very specific. With a procedure that allows doctors to examine transplant tissue directly through a microscope for any signs of rejections. The procedure to obtain the tissue sample, endomyocardial biopsy, is performed in the cardiac catheterization laboratory. The procedure takes only about 15 minutes and involves putting a narrow catheter into the right ventricle of the heart through a vein in the neck. A tiny device at the tip of the catheter retrieves the tissue sample and the catheter is withdrawn. The test may be performed weekly for the first two months after transplant surgery, then less frequently over the first year, until on average, the procedure may be required only about every three months. The results are usually known within a day or so.

Transplant coronary artery disease. Coronary artery disease, which is the accumulation of plaque in the arteries that supply blood to the heart, is usually a very slow process. It usually takes 40 or 50 years before any problem such as chest pain or heart attack occurs. For heart transplant patients, the body's immune reaction to the new heart may result in scarring in the coronary vessels, which in a very few patients, may result in impaired blood flow to the heart. Because the nerves that would otherwise produce chest pain are separated during surgery, the problem is not signaled by symptoms and must be identified by angiography, the cardiac catheterization procedure that allows problems to be demonstrated on x-ray pictures after injection of dye into the heart and coronary arteries. This test is usually performed two to four months after transplant surgery to establish a baseline picture of these structures, then repeated annually afterward to permit rapid detection of any problem.