What is a heart transplant?

The first heart transplant was performed in 1967 by South African surgeon Christiaan Barnard at the Groote Schuur Hospital in Cape Town, which has since become world famous.

Barnard placed the heart of a young woman who had died in a road accident in the body of a 55-year-old man.

A heart transplant is the last resort for people with heart failure in whom the heart muscle is no longer strong enough to keep the blood circulation moving. In a major operation, the weakened heart is replaced by a donor’s heart. If a donor’s heart is not immediately available – which unfortunately is often the case – then the waiting time is bridged by a mechanical support heart as a bridge to transplant.

The heart transplant technique has been around for more than forty years. In the beginning, the outlook after a heart transplant was not very good. Today, approximately 4,000 heart transplants are performed worldwide every year, and the chances are much better. Nearly 155 heart transplants occur in India every year, and this number is rising due to low heart transplant cost in India. About 85 per cent survive the first year after the transplant, and after ten years, half are still alive.

Cost of a heart transplant in India

The number of heart transplants has picked up an enormous pace in the last few years in India. The average heart transplant cost in India is about USD 30,000 to 45,000. There are at least 10 hospitals spread around India that perform heart transplants regularly. The cost in India is about 1/6th of that in the US but with a similar success rate.

There are many types of heart transplants, and the costs vary depending on the complexity of the operation. Traditional open heart surgeries cost less. Advanced techniques such as robot-assisted heart surgery are available in India.

The ideal receiver

Donor hearts are relatively scarce, and not everyone with acute heart failure is eligible for a heart transplant. The conditions that the recipient must meet are intended to increase the chance that the recipient will recover with the donor’s heart. Some of these conditions are medical, but others are more social in nature.

A medical condition is, for example, the blood pressure in the lungs. If the blood pressure is very high, the donor heart could have problems with it. A healthy donor heart is not used to pumping up at high pressure. Other conditions may be that there are no severe problems with organs such as kidneys, lungs, and liver.

The obvious social condition is the age of the recipient. In the past, a strict age limit was applied in different hospitals, but nowadays it all goes a little more smoothly. The idea is that there can be quite a difference between the biological age and the age on the calendar. Some elderly people with a donor’s heart are doing very well. Someone who is addicted to smoking, alcohol or drugs is not ideal for a heart transplant.

The ideal donor

The ideal donor is young and healthy, but the lack of donor’s hearts has meant that healthy men over 45 and healthy women over 50 are eligible as donors.

Donor and recipient must match. They must be about the same in body size, because the bigger the body, the bigger the heart. A small person’s heart in a giant’s body would pump more blood than it can handle. Finally, the blood type must also match.

Rejection reaction of the immune system

After a heart transplant, the recipient must take medication for the rest of his life to limit the immune system’s response to the foreign body. A small revolution in this area was the introduction of cyclosporine, a drug that eliminates the immune system and thereby suppresses the body’s rejection response. Such immunosuppressive drugs sometimes have serious side effects.

A transplanted heart has no connection to the nervous system, it is attached without nerves. A healthy heart is warned via the nervous system when the body makes an effort so that it can beat faster. A transplanted heart does not receive that signal, so it takes a little longer before it adjusts its rhythm. On the other hand, there are no pain signals from the heart either. For example, someone with a transplanted heart does not suffer from chest pain.