Heart and Lung Transplant

Organ transplantation is the replacement of diseased organ with a healthy organ obtained from patient-donor. In heart and lung transplantation both the diseased heart and lungs will be replaced simultaneously with a healthy heart and lungs obtained from a human donor. Heart and lung transplantation requires suitable donors and potential donors are patients who are declared brain-dead but on life-support, having no heart or lung diseases.

It is recommended as a treatment in patients with following conditions:

• End-stage heart and lung disease
• Complex congenital heart disease
• Eisenmenger syndrome (atrioventricular canal defect, transposition of the great vessels, and truncus arteriosus)
• Irreversible right-sided heart failure resulting from pulmonary hypertension

Heart and lung transplantation is not suitable for patients having impaired kidney and liver function, insulin dependent diabetes mellitus and other serious disorders. Patients who require heart and lung transplantation should undergo stringent screening procedures that assess the overall physical and psychological health. A thorough medical history which includes history of previous cardiopulmonary disease, infectious disease and family history is taken.

Surgical Procedure

Donor operative procedure

The patient is given general anesthesia and made comfortable throughout the procedure. The surgeon makes an incision through the centre of the breast bone for initial inspection of the heart and lungs. The heart and lungs are then mobilised without harming the lung tissues. The heart is flushed using cold cardioplegia solution and at the same time the lungs are flushed with cold, modified Collins solution. Then, the heart-lung block is removed and placed in a sterile, cold electrolyte solution for storage. Trachea should be closed during storage and transport.

Recipient operative procedure

The surgical procedure in the recipient is performed under heart-lung bypass machine which maintains the blood circulation and oxygen levels of the body. The diseased heart and lungs are removed. The phrenic nerve and bronchial artery circulation is preserved so that post-operative complications are avoided. Then, the donor heart and lungs are inserted followed by fusing of the trachea, right atrium and aorta. After the completion of this procedure the heart-lung bypass support will be disconnected.

Risks and complications

Some of the potential risks and complications involved with heart and lung transplantation procedure include:

• Transplanted organ failure
• Rejection of the transplant
• Infection because of anti-rejection medications (reduce body’s ability to fight infections)
• Blood clots
• Stroke

Recovery

Recovery from organ transplant takes a long span of about 6 months. Anti-rejection medications should be taken as prescribed to prevent rejection of the transplant. Frequent follow-up visits and routine blood tests will be necessary.