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Advanced Centre For Heart Transplant at Fortis Hospitals, Chennai

Giving someone a gift of life is the noblest thing to do. Imagine getting a second chance at life. Anyone would jump and grab it.

At Fortis Hospitals, Chennai, our Department of Heart Transplant does exactly that!

Pumps life back!!!

Heart transplant’ is a surgical process in which a healthy heart is removed from a donor and is used to replace the heart of a recipient who is either at the end-stage heart failure or suffering from a severe cardiac disease and where medicines or other surgeries has not healed recipient heart. The donor heart usually comes from a brain dead or a deceased person.

A heart transplant is a major operation and we at Fortis Hospitals, Chennai are at the forefront of transplantation. The team works to make it a smooth journey for both the patient and their families. We have a group of highly skilled heart surgeons who are adept at handling simple to complex cardiac diseases. They are supported by state-of-the-art infrastructure and diagnostic facilities that equip them to provide the most comfortable care possible.

Our team of heart surgeons consists of transplant surgeons, cardiologists, intensivists/critical care specialists, pulmonologists, immunologists, pathologists, trained ICU & ward nurses. They work in collaboration with other specialties and departments to ensure the highest level of personalized care.

The ideal candidate for a heart transplant

Due to short supply of donor’s hearts, a careful selection process is usually in place to assure a fair distribution of donor’s hearts. A person undergoing a heart transplant has to be ill enough to need a new heart but at the same time healthy enough to receive one.

An inadequate functioning of the heart is not the only criteria for undergoing a heart transplant. All the other organs in the body of the recipient must also be in good health and shape. The transplant cannot be performed in patients with cancer, someone with an active infection, a serious kidney, liver or lung disease, a smoker or an alcohol addict. Each case is considered individually and checked on the merit of recovery, ability to do lifestyle modifications and compliance with medications.

 

 

The process

The process begins when a suitable donor heart is found whose parameters match with the recipient’s requirements. The waiting times to find a donor heart can sometimes be very long. Once the heart is removed from the donor’s body, it is preserved on ice and is suitable to be implanted within 4 hours of removal.

A general anesthesia is given to the recipient as it involves an open heart surgery. The recipient is put on a ventilator and medicines are given through an IV line injected into the arm. The surgeon opens the chest and connects the recipient’s heart’s arteries and veins to a heart-lung bypass machine and removes the damaged heart. This process can be simple or complex depending on whether the recipient has undergone any previous heart surgeries in the past.

The next step is the removal of the recipient’s heart’s arteries and veins from the machine and connecting them to donor’s heart and placing it. The operation is completed when the surgeon closes the chest by taking stitches.

The recipient is usually back home after about a week of undergoing a heart transplant. Sometimes the stay is extended to two weeks or more to monitor and stabilize various health parameters. The recipient is then engaged in a cardiac rehabilitation program which is medically–supervised. Here the patient learns about maintaining a healthy heart health. It involves educating, counselling and training patients on exercises, choosing right nutrition, managing stress, avoiding risk factors for maintaining a healthy heart.

Watching out for rejection

Post heart transplantation, the recipient is constantly monitored for organ rejection. Our body’s immune system rejects any foreign objects be it bacteria, viruses or organs. A standard test called a heart biopsy is done to check whether the body is rejecting the new heart. This test is conducted multiple times over few months post-surgery. This is done along with administration of immuno-suppressants – a powerful medicine that suppresses the body’s immune system and avoids rejection. Symptoms like shortness of breath, fever, fatigue, weight gain and reduced amounts of urine are closely monitored and checked as these are the first signs of rejection. Your doctor might change the type or dose of immuno-suppressant if the existing medications doesn’t seem to work or cause more side-effects.

Regular follow-up

The patient will require to follow-up regularly for medical check-ups with their transplant cardiologists. The doctor will check the levels of medications needed, side-effects, any active infection and may order heart-related diagnostic tests to evaluate and monitor heart rhythm and function.

Emotional Support

Going through the process of waiting for a donor, undergoing surgery and recovering can be long-drawn, stressful and overwhelming. All these feelings are normal. Talking to your doctors and our supporting staff can be relaxing and will help you keep anxiety at bay. Having your family, friends or seeking professional counselling can go a long way in coping with this trying time.

 

 

Importance of Lungs and What is Lung Transplant?

‘Hey, relax. Breathe in and breathe out.’ All of us have said or heard this at some stage of our lives. Breathing is considered to be a natural and relatively easy activity. However, there is a mighty power-house behind this seemingly easy activity. Lungs are the core of the human respiratory system. They are responsible for inhaling fresh air into the body while exhaling bad gases in parallel.

 

If the importance of lungs were to be explained in 4 words, those would be: ‘No breath, no life’. Unfortunately for some people one or both lungs are overtaken by disease making it difficult for the human to function and hence may become candidates for a concept called ‘Lung Transplant’. It is a surgical procedure done to replace the diseased or failing lung with a healthy lung, usually from a deceased donor. Like any other organ transplant, lung transplant is considered to be the last resort for a failing lung and is only suggested after all possible treatments and lifestyle changes have failed to bring about any significant improvement. Depending on the medical condition, a lung transplant may involve replacing one or both the lungs.

When is a Lung Transplant needed?

Typical cases that demand a lung transplant include:

  • Chronic obstructive pulmonary disease (COPD)
  • Scarring of the lungs
  • Pulmonary hypertension
  • Cystic fibrosis
  • Sarcoidosis
  • Severe bronchiectasis

Apart from the above obvious conditions that warrant an urgent solution, lung transplant is recommended when the patient has an acceptable health/ nutrition/mental health status and would suffer from a drastically limited life expectancy in the absence of the transplant.

Eligibility for Lung Transplant

All lung transplant applications are scrutinized in detail since it may not be the most beneficial/applicable therapy in all cases. Numerous tests such as chest CT scan, pulmonary function tests and cardiac stress tests are performed during a lung transplant evaluation.

 

A lung transplant application may be considered ineligible if you:

  • Are unwilling or unable to make lifestyle changes necessary to keep your donor lung healthy, such as not drinking alcohol and/ or not smoking
  • Are greater than 60/65 years of age
  • Have a recent personal medical history of cancer
  • Have serious life-threatening systemic diseases such as kidney, liver or heart diseases
  • Don’t have a good support system

Types of Lung Transplants

  • Single lung: Transplant of one lung
  • Double lung: Transplant of both lungs
  • Bilateral sequential/ Bilateral single: Transplant of both lungs, done one at a time
  • Heart-lung transplant: Transplant of both lungs and the heart taken from a single donor

Most lungs that are transplanted come from deceased organ donors (cadaveric transplant). Living transplant includes donation of a part of the lung (called lobe) from healthy, non-smoking adults who are a good match. People who donate a lung lobe can live in a good physical shape with the remaining lungs.

Preparing for Lung Transplant

Although the emotional toll of waiting for the patient’s health to improve whilst desperately waiting for a transplant can be daunting and exhausting, tests suggested by the doctor should be performed at suggested frequencies and a positive, optimistic attitude must be maintained. When a suitable match is identified basis matching of blood group, lung dimensions and other parameters, the patient will be immediately called in for the surgery. The surgery includes incisions in the chest to replace the lung. Basis the complexity, this surgery lasts from anywhere between 6 to 12 hours.

Post-surgery risks

Like any other big surgery, lung transplant comes with its own share of risks. Although science has advanced vastly over the past decades, complete mastery over the human body’s functioning is something mankind has still not been able to achieve. The biggest risk of a lung transplant surgery is organ rejection. This occurs when the immune system believes that the new lung is a foreign body and considers it to be a disease. Severe rejection could lead to failure of the donated lung.

Other risks include:

  • Bleeding and infection
  • Cancer and malignancies due to immunosuppressants
  • Kidney damage
  • Severe pulmonary edema (fluid in the lung)

It is thus paramount that the patient and his/her family put utmost faith in trained and experienced medical professionals and follow their instructions with utmost care. The patient should also strictly avoid skipping any medications prescribed by the doctor pre and post surgery.

Why FORTIS?

Fortis has the highest survival rate among institutes in India that perform lung transplant surgeries. They are not wary of complex cases and consistently push their boundaries to develop their expertise, deliver better and leave no stone unturned in keeping all up to speed by doing the right diagnosis, having detailed discussions with the patients and their families to explain the procedure in detail and then performing transplants with international standards of accuracy and success rate. Since the surface area of a patient’s lungs is constantly exposed to potential airborne pathogens, it becomes more complex to extend post-surgery care to a lung transplant patient. However, at Fortis, a dedicated team of experts works closely with the patient since his/her diagnosis until discharge to ensure that utmost care is extended at all stages especially the recovery stage. Since the inception of the program in Chennai, the Fortis team has performed over 2000 lung transplants. Infact, Fortis’ lung transplant outcomes compare favorably with not just the national average, but the global overage.

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