IN THE PRESENT
A heart transplant is a surgical operation to replace an ailing heart of a person with a
healthy heart. It is a very delicate operation and not exempt from complications. For this
reason heart transplants are performed only on people evaluated adequate by a
specialized team.
If the operation and the recovery proceed without complications the patient sensitively
improves his/her own quality of life.
The donor is not chosen at random, but /he/she must have in common with the receiver
the blood group and the size of the heart.
Since it is difficult to find appropriate donors the requests for transplants exceed the
availabilities.
The two main causes of death of the patients are:
1. Rejection of the organ
[link]Rejection happens when the immune system attacks the installed organ because it
considers the new heart extraneous to the organism.
The danger of the rejection is less likely in the course of time but, it doesn't run out
completely, therefore after months or years the patient can die for this reason.
2. Failure of the transplant
[link]For failure of the transplant we mean the situation in which the new heart suddenly
interrupts pulsation or its action doesn'
t even start. In such circumstances, the patient is in
serious danger of life.
The survival of a heart transplants in Italy is currently about 10 years even if , in some
exceptional cases, the patient can also live 20 years after the operation.
In the case of failure, a second or a third transplant can also be realized.
HOW ORGANS ARE TRANSPORTED FOR THE TRANSPLANTS
Immediately after the withdrawal, the organs are put in a plastic bag (in a container full of
ice) where the temperature of the heart must be around 4-10°C.
In this way, the hearts stop beating and the organ begins to deteriorate.
Consequently the doctors have only around five to the ten hours to transplant the organ
from the donor to the receiver.
If the trip is too long, the organ cannot be used and it will be wasted.
IN THE PAST
There are many legends about the birth of organ transplants, but certainly the scientific
history of transplants began in 1902. A French surgeon who had moved to Chicago,
Alexis Carrel, first succeeded in finding a technique that could gather together the blood
vessels stitching them with thread and clips. This was fundamental in order to transplant
an organ, in fact without it the operation wouldn’t be possible.
The experimental phase of heart transplant began in 1905 with Carrel Guthrie, who
operated a cardiac heterotopic transplantation between dogs.
The first global heart transplants was performed the 3 rd of December 1967 by the South
African surgeon Christiaan Barnard at the Groote Schuur hospital of Cape Town, on a man
of 55 , who died after 18 days. The donor was a 25 years old girl, who died in a car
accident.
In 1978 a medicine called cyclosporine, that could contain the rejection of the extraneous
organs was developed. [link]
When the immune system of the receiver determines thereaction of rejection the body
doesn't recognizes the cells of the transplanted organ. Cyclosporine modified radically the
possibility in succeeding with the transplants of kidney, liver and heart.
Cyclosporine it’s an active substance used to contrast the rejection of transplants. It
deletes the activity of immune system and it is composed by the following chemical
elements.
C 62 H 111 N 11 O 12.
The first operation of cardiac transplant in Italy was executed the 14 th of November 1985 in
Padova, by the team of the professor Vincenzo Gallucci, who successfully transplanted
the heart of an 18 year old who lived for other 7 years.
In the future (what science and medicine are creating)
During the years science and medicine have improved a lot in the medical field. The most
important projects at the moment are the “Care System Organ” and the “artificial heart”.
Care System Organ
A team of doctors and engineers in Massachusetts is trying to extend the time spent for
the transportation of organs before the transplant. The “Transmedics” of Andover has
developed a experimental device that’s able to maintain heart and lunges “alive” during the
journey, known as the “Care System Organ”. The machine hasn’t been approved in the
United States yet, but 8 hospitals in the country are testing it for clinical use.
In a preliminary study, this system has been used with success in 12 transplants. The hope is
that these machines will be able to increase the rate of success of the transplants.
Conceptually the artificial heart has a simple mechanism (a muscle that works as a pump).
However, it’s still in the experimental phase because of some restrictions due to the
cardiac materials and the instruments that have been used that makes it more likely to be
rejected from the organism. Furthermore, this machine needs external batteries that make
it harder for the patient to move. Because of these complications, the individuals who
receive of these artificial hearts for just a few hours or days.
Finally 10 questions and curiosities related to the cardiac transplants
WHO ASSUMES THE EXPENSES FOR A TRANSPLANT?
The costs of the transplants are paid by the National Sanitary Service, there are no costs for the patients. Moreover it is illegal to buy or to sell human organs: the donation is always free and anonymous.
CAN I KNOW WHO IS THE FAMILY THAT DONATE THE ORGAN?
No, almost all over the world the identity of the donor stays anonymous. At the
beginning of the era of the transplants serious cases of depression are found in the
patients that knew of the identity of the donor.
WILL THERE BE A STRONG PAIN AFTER THE OPERATION?
The operation causes a wound above the sternum that scars after 6-8 weeks attenuating the pain.
AFTER THE OPERATION DO I ALWAYS HAVE TO TAKE MEDICINE?
To avoid the rejection and other problems caused by the transplant, there are some medicine that must to be taken for the entirelife time.
WILL COLD AND FLU BE MORE FREQUENT?
Because of the weakening of the immune system, transplant patients are more exposed to infection. When you feel some abnormal symptoms it’s necessary to consult a doctor.
AFTER A HEART TRANSPLANT DO I HAVE TO GIVE UP SOME FOOD OR
DRINKS?
Patients have to follow a strict diet. Foods that have to be given up are: raw meat,
raw eggs, “blue” cheese and grapefruit, because they can cause infections or
modify the rate of the medicines into the blood. Regarding drinks, alcohol has to be
drunk with moderation but you can always drink a glass of wine or champagne at a
party.
ARE THERE ANY PARTICULAR SANITARY CONDITIONS TO RESPECT?
During the first 3 months you should avoid huge crowds and wear a mask when you
go to the hospital for visits.
WHO WILL HELP ME AFTER THE OPERATION TO GET ME IN SHAPE?
A few weeks after the operation heart transplants have the right to go to a rehab
where they’ll follow a training programmeunderthe control of a doctor.
CAN I PRACTISE ANY SPORT?
Yes, you should train more than 2 times days a week, but you should avoid any
kind of dangerous sport and lifting heavy weights (>5kgs).
WILL I BE ABLE TO HAVE CHILDREN?
Men don’t have any kind of problem but women should avoid pregnancies during
the first years after the transplant. After that time the pregnancy is possible but
more risky.