According to the Mayo Clinic, a “heart transplant is an operation in which a failing, diseased heart is replaced with a healthier, donor heart. Heart transplantation is a treatment that is usually reserved for people who have tried medications or other surgeries, but their conditions have not improved sufficiently.” The Mayo clinic underscores this definition declaring that the operation is major surgery with a good chance of survival for those who receive appropriate recovery care.
My experience was based on the Mayo Clinic’s very realistic evaluation of the process including qualifications for transplantation, wait list experiences, surgical procedures and aftercare practices. From the patient’s perspective, those are the physical phases of heart transplantation.
But, heart transplantation is more than that, much more. It will affect every aspect of your life for the rest of your life. It is a physical and psychological trip that has mountainous highs and steep valleys. The ride is not always smooth but can be exhilarating and when push comes to shove, the chances are good that you will live a longer life with surprising benefits.
Successful heart transplantation requires strict compliance before and after the surgery. This means consuming powerful medications that will attack every other organ in your body, monitoring your liquid intake and eliminating your salt intake. Without compliance the patient makes a difficult trip an impossible journey.
The patient’s cardiologist will monitor your medication on a very regular schedule. If you are non-compliant while on the wait list, you will not receive the new organ. The donor, the transplant team, the transplant center and your loved ones will be counting on you to do your part. It will not always be easy. It will not be fun. And, you are taking an organ that would be appreciated by other people on the wait list.
Yes, heart transplantation comes at a price. Not only significant monetary considerations but at physical and emotional tolls for the recipient and all those close to the recipient. If you were active before the transplant, you can be active again; emotionally, physically and sexually. But, the aura of responsibility is always there.
The idea that a heart transplant recipient will receive the organ and then return to the same lifestyle is not the way it works. Actually, every heart transplant is unique but similar in many ways. It would be rare that there were no lifestyle changes. The chances are good that your diet will change substantially. Your capacity for activity should increase. It would not be unusual that your life and the lives of those close to you take on new perspectives.
The reality is that the extension of your life comes with the risks of a very invasive operation. After the operation, the very medicines that protect you from rejection of the new organ by the rest of the body compromise your immune system. These helpful drugs extend your life at the cost of a compromised immune system. You are rendered defenseless against multitudes of damaging possibilities. There is no such thing as a common cold. Every scrape can become a launching platform for infection.
All the physical illnesses that were once no-brainers are serious issues. A temperature of 100 can equate to a temperature of 103 in your former life. Infections can enter the body, the lungs and other areas. In my case, a fungal infection moved from my left lung to my spine and necessitated removal of a section of my spine and removal of two ribs. The ribs were placed in the gap in my spine along with a steel rod, chicken wire and a steel plate. A year and six months later, there is residual 24/7 unrelenting pain. This is certainly not typical of the heart transplant process. It is an extreme case, but things like this can happen. Before the transplant, I had been exposed to this mold before but had an immune system to fend of the fungus.
Every heart transplant recipient must understand the consequences of a compromised immune system. They are long-lasting and far-reaching.
Who is eligible for heart transplantation?
Heart transplants are performed when other therapies for heart problems have failed. In adults, heart failure is caused by:
- Coronary heart disease
- Weakening of the heart muscle
- Valvular heart disease
- Congenital heart defect
- Failure of a previous transplant
Heart transplantation is not for everyone. Most centers have conditional policies regarding transplant candidates:
- Age – Usually must be in the program by 65 or 70 in some centers like Tampa General Hospital.
- Conflicting medical conditions.
- Serious blockage in arteries.
- Medical history of cancer.
- Non-compliant lifestyle
The Ventricular Assist Device is an option many centers use for patients who have not received an organ at a good time. The insertion of this miniature pump is a major surgery similar to open heart surgery.
As a matter of interest, the Mayo Clinic has heart transplant teams in Arizona, Florida, and Minnesota, the home of the renowned clinic. The Clinic has found that one immunosuppressant, sirolimus or rapamycin has proven to increase kidney function in some transplant recipients.