The circulatory and respiratory systems of the human body are the most prominent biological systems. Its functioning is indispensable to daily life, therefore, the functioning of these systems are of vital importance. Functions of all other systems revolve around the heart and the lungs. The functional capabilities of these organs can be disrupted by a variety of conditions as they are working constantly. The heart function with pumping the blood around the body and is essential to the transport of nutrients. While the lungs function as filters with the primary task being the exchange of gases and transporting it via the bloodstream.
Due to certain illnesses or conditions stemming from either environmental or hereditary roots, some organs cannot be brought back to normal working order therapeutically. In such situations, the last resort is organ transplant. Organ transplant is a very complicated process both medically and logistically and requires a thorough infrastructure to carry out successfully. Dr. Rela’s Institute & Medical Center is the pioneer and the Centre of excellence in the field of transplantation, we are equipped with the latest equipment and the most advanced technology along with the experienced expertise personnel required for the treatment of heart and lung failure and the procedure involved in Heart and Lung Transplant. From surgery preparation to post transplant care, we provide all the pertinent services required by the patient to integrate back into normal life.
What is Organ Transplant?
Organ transplantation is a surgical process that involves the transfer of a healthy organ from one body to another. The person from whom the organ is taken is called the donor and the individual who receives it, the recipient. This procedure is often performed on patients suffering from organ failure. Due to the complex nature of the surgery, it involves a lot of deliberation and consultation and is not performed as often as other surgical procedures.
Steps involved in organ donation
Before a heart or lung transplant can be carried out, there are certain steps that need to be carried out. Here are the sequence of events that precede an organ transplant:
Identifying a potential donor: When a patient passes away in a hospital and the family is willing for organ donation or has pledged their organs for donation, a medical professional assesses the cadaver and sees if it is fit for organ donation.
Donor eligibility evaluation: A team of professionals comb through the donor’s history before providing approval for donation.
Organ recovery authorization: This involves getting the necessary permissions from the family members or next-of-kin of the donor to go ahead with organ recovery.
Matching recipient request: Once a recipient request arises, the blood type and body size of the potential donor and recipient are examined to check if they match. This is done through a directory of potential organ donors.
Organ recovery & transport coordination: Once a match has been found, the next step involves the recovery of the organ from the donor. This is followed by preparing the organ to be transported to the hospital where the surgery is to take place.
Recipient preparation and surgery: The patient is prepared for the surgery followed by the transplantation.
Follow-up care: Post surgery, the doctors will prescribe follow up tests and advise the recipient to have regular check-ups in order to avoid complications and monitor the integration of the new organ into the body.
Organ Retrieval Banking Organisation (ORBO) is the most commonly used platform by prospective recipients in India looking for donors.
When is organ transplant considered?
Since an organ transplant is a complicated process and carries associated risk, it is not employed for all diseases. The grounds for a lung or heart transplant include:
A pulmonary disease that has progressed to an advanced stage
A cardiac disease that has reached critical point
Likelihood of reducing life expectancy
Severely restricts daily activities
Physically and mentally fit to undergo a transplant
The most common diseases for which lung transplantation is considered are as follows:
Idiopathic Pulmonary Fibrosis (IPF): Idiopathic pulmonary disease refers to the fibrosis of the lungs(lungs become like a fibre) due to undetermined causes. The fibriosis worsens with time and ultimately reaches a point where it is almost difficult for the lungs to expand & exchange oxygen with the blood. Medication can only slow the progress of IPF and cannot ensure complete recovery. Hence, lung transplantation is often considered.
Chronic Obstructive Pulmonary Disease (COPD): It is an inflammatory disease of the lungs which restricts the movement of air in the lungs. It is a progressive illness and symptoms tend to get worse over time. Common symptoms include mucus, cough, wheezing and trouble breathing. Although the symptoms can be managed with medication, it is difficult to completely recover from COPD this way. Owing to the chronic and progressive nature of the illness, sufferers from COPD are considered for a lung transplant.
Cystic Fibrosis: It is a possibly fatal disease that primarily affects the lungs. Caused due to a hereditary disposition, cystic fibrosis can drastically reduce the life expectancy of the patient. The disease is characterized by the production of mucus which is thicker and stickier in consistency and leads to more serious complications like diseases of the liver. There is no existing cure for the disease and the life expectancy of those afflicted hovers around the mid 40s. These factors make patients suffering from cystic fibrosis eligible for a lung transplant.
Sarcoidosis: It is the formation of small collections of inflammatory cells, known as granulomas, on the body, particularly the lungs. An inflammatory disease, the exact cause of sarcoidosis is unknown and it is often labelled as an autoimmune disorder. However, it can progress to a point beyond recovery and lead to organ failure. In these instances, a lung transplant is the only option.
Lymphangioleiomyomatosis (LAM): A rare disorder, it is characterized by the abnormal growth of smooth muscle cells in the lungs which leads to the formations of cysts or holes. LAM is mostly diagnosed in women and the typical symptoms include chest pain, shortness of breath, cough and wheezing. LAM could lead to a collapsed lung, pleural effusions and complete respiratory failure. Lung transplant is recommended for those suffering from LAM.
Other lung diseases that might warrant a transplant include Vascular Lung Disease, Chronic pulmonary emboli, Drug toxicity, Bronchiectasis, Obliterative Bronchiolitis, Suppurative Lung Disease and Emphysema.
The most common diseases for which a heart transplant is considered are as follows:
Constrictive Pericarditis: It involves the chronic inflammation of the pericardium which is a sac-like membrane that surrounds the heart. This chronic inflammation leads to loss of elasticity of the pericardium which ultimately leads to scarring followed by organ failure. If detected early, a surgical procedure termed pericardiectomy can be performed. If left untreated beyond a certain point, heart transplant is the only remaining option.
Pulmonary Hypertension: It is a type of high blood pressure that affects arteries within the lungs. Some of the most striking symptoms of pulmonary hypertension include: shortness of breath, fatigue, chest pain, palpitations and edema or fluid retention in the legs. Pulmonary hypertension can be diagnosed by an echocardiography or doppler-echocardiography. However, right-heart catheterization remains the gold-standard diagnosis and the treatment depends on the type of Pulmonary Hypertension- arterial, venous, hypoxic, thromboembolic, or others. Since the heart has to work extra to pump blood into the lungs, PH can turn life-threatening as it progresses if left untreated. Early detection and diagnosis can help alleviate the symptoms to an extent and thereby improve the quality of life.
Coronary Artery Disease (CAD): It is characterised by the deterioration of blood vessels that supply to the heart. The primary reasons for the onset of CAD are inflammation and the build-up of cholesterol containing deposits known as plaque. Symptoms include heart attacks, shortness of breath and chest pains. Although CAD can be reigned in with lifestyle changes, more serious cases require a transplant surgery.
Cardiac Tumor: It involves tumors or abnormal growth occurring in the heart and its valves. For the most part, cardiac tumors are benign. However, they can disrupt the normal functioning of the heart. If it cannot be removed surgically or by other means, then a heart transplant is considered.
Cardiac Amyloidosis: It is a condition that occurs when plaques made of a protein byproduct known as amyloid builds up in the heart muscles. This severely disrupts the pumping action of the heart and affects its functionality. It is an irreversible condition that worsens with tame. Heart transplant surgery is recommended as a last resort for this condition when medication proves ineffective.
Heart Valve Disease: It is a serious disorder where the valves in the heart stop functioning properly. There are 4 valves in the body and disruption in their functionality can lead to improper blood flow through the heart. The most common risk factors that lead to heart valve diseases are age, infections, heart attacks and lifestyle diseases like diabetes, high blood pressure and cholesterol. Since other less riskier forms of surgery can correct the situation, heart transplant is considered as a last resort.
Other heart diseases that might require a transplant include Ventricular Tachycardia, Cardiomyopathy, Myocarditis, Hemochromatosis and Pulmonary hypertension.
One of the complications of a transplant surgery is the rejection of the new organ by the body’s immune response. Therefore, much of the post transplant care revolves around tackling this issue. The process is called immunosuppressant therapy and it is achieved in two steps. The first step, termed induction therapy, involves a high-dose of immunosuppressants in order tame the immune system post surgery. A combination of antiviral and antibiotic medication is also simultaneously administered in order to reduce the risk of infection due to a weakened immune system. The next stage is known as maintenance therapy and involves lower dosage of immunosuppressants to keep the immune system under control.
The recovery process post surgery can take anywhere from 3 months and extend to 6 months as per the individual’s physique. A combination of medical and psychological help is required by the patient to achieve a swift recovery. Although normal activities can resume post surgery, it is vital that tedious physical activities be completely avoided during this period. Also, a series of follow-up tests needs to be done every 2 to 3 weeks in order to ensure everything is functioning normally. It is recommended that the patient visit a medical professionally periodically to avoid the risk of complications arising.