Heart transplant is a type of surgery used for patients who are in ‘end-stage heart failure’. Were these diseases such as ‘Birth defect’, ‘cardiomyopathy’ and ‘coronary’ can lead to End-stage heart failure’. These are the three main diseases that can cause end-stage heart failure, but out of the three, Cardiomyopathy is most common among the three.
Cardiomyopathy also known as heart muscle disease is a progressive disease where the heart muscle becomes bigger, thicker or stiff causing difficulties for it to pump properly. In rare cases, the muscle tissue in the heart is replaced with scar tissue. As it worsens the electrical rhythm of the heart becomes weaker and weaker. Without treatment, those who have Cardiomyopathy will have a discouraging future, among every three patients who are diagnosed survive for more than five years. This is one of the primary reasons why heart transplants have increased over the past years.
There are many different types of Cardiomyopathy which individuals can be diagnosed with, such as:
Hypertrophic cardiomyopathy (HCM): where the heart has excessive thickening of the heart muscle with no obvious reason or cause, it could be inherited from genetics, or in other cases persistently high blood pressure.
Dilated cardiomyopathy (DCM): This causes the heart to enlarge or dilate as shown in diagram 1, there is no proper explanation why DCM can be developed, but researchers have discovered that excessive consumption of alcohol is known to be a cause. Dilated cardiomyopathy can build up over the years without showing any significant physical symptoms. However, as time advances the enlarged heart gradually will weaken, which is called heart failure.
This is a diagram 1 of a dilated heart. <svhhearthealth.com.au>
Arrhythmogenic right ventricular cardiomyopathy (ARVC): is a genetically enhanced disorder where cells in the heart are gradually replaced with fibrous and fatty tissues. This causes the heart to also dilate causing the action of pumping to weaken. Yet again there is an unknown cause why or how this condition develops in the body, but has a tendency to run through family medical history.
Restrictive cardiomyopathy (RCM): The least common type of heart disease is restrictive cardiomyopathy which causes the walls of the heart muscle to become hard and stiff. This limits the flow of blood going through the heart. Later leading to problems with blood flow to the whole body. The cause is unknown but has been linked to very rare metabolic conditions which may have again been genetically inherited.
If medical practices have failed to heal, cure the diseases, or if the symptoms become more severe, the heart will go to a stage called ‘End-stage heart failure’. This is a condition when the heart can no longer pump blood effectively and will need a transplant, over 5 million people will experience this.
The heart is a muscular organ which acts as a pump in the circulatory system. It is approximately the size of your fist and is located slightly to the left of the middle of your chest. The heart muscle contracts and expands, the right ventricle pumps deoxygenated blood (low in oxygen from cell usage) directly into the lungs where it becomes oxygenated (oxygen-rich), returning to the heart where the left chamber transports it throughout the body. Without the heart our blood would be unable to release oxygen into the cells in our body causing our cells to not receive enough oxygen and nutrients to survive. Our blood is made up of salts, proteins, plasma red blood cells and even white blood cells.
The red blood cells supply essential nutrients for our cells, like amino acids, fatty acids, and glucose. They remove carbon dioxide, urea and lactic acid from our bodies which are deadly toxins, we remove carbon dioxide by exhaling. Hemoglobin is the protein inside red blood cells that carries our oxygen.
White blood cells (also called leukocytes or leucocytes and abbreviated as WBCs) have the role of defending the immune system, they are the cells that protect the body against both infectious disease and foreign invaders.
When your heart is diagnosed with cardiomyopathy your heart muscles become stiff and rigid, unlike the normal heart, causing abnormal behavior. This abnormal behavior is caused by scar tissue, restricting the heart muscles to contract and expand. Scar tissue is not like heart muscle tissue because it does not share the same qualities of a heart muscle, it cannot contract, not allowing the heart to pump. Scars form when the dermis (deep, thick layer of skin) is damaged.
Why does the body form scar tissue? the body forms new collagen fibers (a naturally occurring protein in the body) to fix the damage of the heart, as an end result a scar is created. The new scar tissue will have a completely different texture and quality compared to the surrounding tissue. When too much scar tissue spreads over the heart, the heart becomes unable to pump at all leading to end-stage heart failure, if not treated properly. Comparing this to a healthy heart, it wouldn’t need to form scar tissue in the first place, because the heart muscles are all healthy and strong, not needing any mending. Unlike the diseased heart the heart will pump blood frequently with a strong electronic pulse. A healthy heart would pump the deoxygenated and oxygenated blood through the correct pulmonary vein.
Heart transplant is the medical procedure of replacing a diseased or damaged heart with a healthier one, from a heart donor. A heart donor is someone who has recently died with a healthy heart or is brain dead, meaning their body is being kept alive by a machine but has irreversible loss of all the brain’s functions, including the brainstem. These donors died as a result of a car accident, severe head injury or a gunshot wound.
In order to get a transplant the patient must go through a process of a complicated screening process performed by a team of heart doctors, nurses, social workers, and bioethicists to review your medical history, diagnostic tests, social history and psychological test to see if you will survive the procedure and live a healthy lifestyle afterwards following the continuous care rules needed.
After this procedure is done successfully the patient will be placed in a type of ‘waiting list’ called a transplant list, then will have to wait for a heart donor. The wait may be very long and stressful but The healthcare team will monitor you closely to keep your heart failure in control until a donor heart is found. Some patients even use a Ventricular assist device while waiting in line. According to Mayo clinic “VADs are commonly used as a temporary treatment for people waiting for a heart transplant. These devices are increasingly being used as a long-term treatment for people who have heart failure but aren’t eligible for a heart transplant. If a VAD doesn’t help your heart, doctors may sometimes consider a total artificial heart, a device that replaces the ventricles of your heart as an alternative short-term treatment while you’re waiting for a heart transplant”.
Diagram 2 of VAD <mayo clinic.org>
The VAD is a mechanical pump implanted in your chest that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body, in diagram 2 you can see how the VAD visually looks. Each year in Australia there are an average of 70 people needing heart transplants, however there are only certain amounts of Donor hearts available. Since heart donors are people who have died recently or are brain dead like I’ve mentioned above, you would need to receive consent from the family or person whose died, not everyone agrees in sharing their or loved one’s organs to someone else, this is why heart donors are very limited. Once a donor’s heart is available for the patient to use, the medical practice staff will give the patient medications before the surgery to relax them soon, making them fall asleep.They will not be aware of what happened during the surgery. While they are asleep the doctor will make an incision down the centre of your chest, to open the rib cage and access the diseased heart, later connecting it to the heart-lung bypass machine, which pumps blood through the body while the heart is being operated on. Removes the diseased heart, leaving the back wall of the atria, the upper chambers of the heart, and then the back of the donor’s heart is opened sewn into place seen in diagram 3.
Diagram 3 <webmd.com>
The surgeon connects the new donor heart to temporary pacing wires (to temporarily control the heartbeat) Then gives immunosuppressant medication, to prevent your body from rejecting the donor heart. This complicated operation takes up four to ten hours. A disadvantage in going under the procedure of a heart transplant is receiving immunosuppressants. Immunosuppressant is a drug that reduces the strength of the body’s immune system, this drug is used for transplants so that it decreases the chances of the body rejecting the new organ. The dangers of using immunosuppressant is that it makes the immune system less able to detect and destroy cancer cells or fight off infections, immunosuppressant may even cause malignant tumors. Malignant tumors are made of cancer cells, they invade the nearby untouched tissues where some of the cancer cells spread into the bloodstream or lymph nodes, where they can take over other tissues within the body.
According to Health Direct “Lymph nodes (or lymph glands) are part of the body’s immune system, they filter out harmful bacteria and cancer cells from your body as well as taking the role of fighting infections”. For some patients who will be having to take immunosuppressant their whole life may be prone to have kidney damage, high blood pressure, high cholesterol, diabetes and a condition in which your bones become lean and weak (osteoporosis).The risks of undergoing heart transplant surgery is that it is an open heart surgery where there are high risks for complication during the surgery, such as Bleeding, Infection,Blood clots, Heart attack, Stroke or even Death. There are still dangers after a successful surgery, the body of the patient may even reject the donor’s heart, why this happens is because it is the human immune system’s job to find foreign things in the body that weren’t there before that may cause harm.
Symptoms of rejection researched by Fairview say are “Feeling tired or weak, fever or chills, shortness of breath, fast or irregular heartbeat, drop in blood pressure, swelling of your feet, hands, or ankles, sudden weight gain, flu-like aches and pains, reduced amounts of urine, dizziness or fainting, nausea or loss of appetite.” Positive aspects of heart transplants are that patients can enjoy a high quality of life. Depending on the condition, the patient may be able to return to doing their daily life activities, such as returning to work, participating in their hobbies and sports, and exercise. But will have to discuss with their doctors what activities are appropriate for them. Some women who have had a heart transplant can even become pregnant, giving joy to many young couples who thought they might not be able to have a child of their own, but however will have to discuss with their doctor about considering having children after the transplant. Before they can become pregnant they would need to make adjustments to their medication that are suitable for a pregnant patient since some medications can cause pregnancy complications.
New John Hopkins research suggests that “Heart transplant patients who receive new organs before the age of 55 and get them at hospitals that perform at least nine heart transplants a year are significantly more likely than other people to survive at least 10 years after their operations.” Is it right or wrong to use science in this way? There have been many events in the past which have raised many ethical, moral and societal issues regarding the supply of donated organs to the right patients, the price of a new organ and if transplants are really that efficient. Is it right to use science to fix these issues? I believe that it is right to use science for the sake of saving others and helping others in need. If science was not used for transplants, many innocent citizens of earth would have died due to an untreated diseased heart or an inexperienced procedure which hasn’t been tested yet causing them more difficulties to their heart. In science it is extremely valid to perform several experiments to test something before it can be proved as accurately correct and safe. Imagine if transplants and medications given weren’t tested or scientifically proven safe! Society should be focusing more on medical treatment, since health goes first, without a healthy working body you can’t do anything you enjoy in life, so there is no point in focusing on something else. If medical practices and medicines are more improved it will help reduce the amount of people suffering in the world from sickness. Even though it is an issue , I believe it is right to use science in this way. My thoughts on heart transplant is that it is a very clever way of saving those in need. Especially to those who are diagnosed with cardiomyopathy, when someone dies with perfect healthy organs, I have a strong feeling that it is a complete waste for it to just stay in a coffin and slowly decompose away into nothing, when it could have been used to save a young bright adult or beloved grandparent. So many lives can be saved with those who are leaving this earth, those who have lived a long happy life can now save those who are too young to pass away. Life is too precious to lose.
Dilated cardiomyopathy n.d., Illustration, St.Vincent Hospital Heart Health, accessed 20 October 2018, <https://www.svhhearthealth.com.au/conditions/cardiomyopathy#section-1>.
Evolution of the Human Heart n.d., Illustration, Co.Thought, accessed 22 October 2018, <https://www.thoughtco.com/evolution-of-the-human-heart-1224781>.
Ventricular assist devices n.d., Illustration, Mayo clinic, accessed 25 October 2018, <https://www.google.com.au/url?sa=i&source=imgres&cd=&ved=2ahUKEwjwlq7VsaveAhUQdCsKHflLBpkQjhx6BAgBEAM&url=https%3A%2F%2Fwww.mayoclinic.org%2Ftests-procedures%2Fheart-transplant%2Fabout%2Fpac-20384750&psig=AOvVaw2odvMlS9tTPHQNcPPDOUMB&ust=1540893478390093>.
WebMD 2018, Heart Disease and Heart Transplant, URAC Seal, accessed 29 October 2018, <https://www.webmd.com/heart-disease/guide/transplantation-treatment#1>.
Heart Foundation 2018, Cardiomyopathy, accessed 26 October 2018, <https://www.heartfoundation.org.nz/your-heart/heart-conditions/cardiomyopathy>.
NSW Government 2016, Cost of care in NSW Hospitals, accessed 21 October 2018, <https://www.health.nsw.gov.au/Hospitals/Going_To_hospital/cost-of-care/Pages/default.aspx>.
Health Direct 2017, Lymph nodes, Australian Government, health department l, accessed 21 October 2018, <https://www.health.nsw.gov.au/Hospitals/Going_To_hospital/cost-of-care/Pages/default.aspx>.
Heart Transplant Surgery 2018, What is a heart transplant?, accessed 19 October 2018, <https://www.healthline.com/health/heart-disease/transplants>.