Treatment Plan

Best Hospitals for Heart Transplant in India

Treatment Plan

Heart transplant surgery is a procedure where a healthy heart from a brain-dead person is transplanted to a recipient suffering from end stage heart disease. A transplant surgery is recommended only when other conventional methods to treat an end stage heart disease have failed completely. Heart transplant surgery is a very risky procedure that should be attempted only when the intended recipient has but a short time to live with his original heart.

A heart transplant surgery is possible only when a donor heart is available. Also, the donor heart should be an ideal match for the recipient. Since a donor heart is rare to get and recipients are more in number, an enrolment into a national organ registry is essential to be on a waiting list.

Not everyone can be a candidate for a heart transplant. In order to get a heart transplant, the recipient must be on a transplant list. However, even before the patient can be placed on a transplant list, they will need to go through a stringent evaluation process.

The transplant evaluation process includes:

       Psychological and social evaluation:  An assessment of the recipient’s social, psychological and financial status is done. The aim is to ensure that the patient has the ability to withstand all types of stress involved.

       Blood tests: A battery of blood tests is performed to ensure the compatibility of the recipient and the donor.

       Diagnostic tests: Various diagnostic and function tests are performed to ensure the status of the vital organs. These tests may include X-rays, ultrasound procedures, CT scan and MRIs if necessary. Pulmonary, kidney and liver function tests are also done.  Women are subjected to a Pap test, gynaecologic evaluation and a mammogram.

       Administration of vaccines: Various vaccines are administered to decrease the chances of developing infections that can affect the transplanted heart.

 

Things To Be Done Before A Transplant:

       The patient needs to be explained clearly what will happen during the surgery and the risks.

       Patient will need to sign a consent form

       Patient will need to fast before the surgery

       Detailed arrangements will be made based on the health of the recipient

 

The Heart Transplant Team Includes:

       Cardiologists

       Transplant surgeons

       Cardiac nurses

       Dieticians/Nutritionists

       Physiologists

       Social Workers

       Researchers

       Pharmacists

 

The Procedure:

Once a donor heart becomes available the surgeon at the transplant center removes the heart from the donor's body. The donor heart will be preserved in a specially cooled solution while being taken to the recipient.  At the same time the transplant surgeon will start preparing the recipient to receive the donor heart.

A large incision is made in the centre of the recipient’s chest to expose the ribs. The recipient’s ribs are then removed to expose the heart. The recipient will be put on a heart-lung machine as the first step of the surgery. The machine takes over the responsibilities of the heart during surgery. The recipient’s heart is then removed except for the back walls of the atria or the hearts upper chambers. Then the back walls of the atria of the donor heart are opened. The donor heart is then sutured to the atrial walls of the recipient. The blood vessels to the heart are then reconnected to the new heart to allow the normal flow of blood. The new heart starts beating once it warms up sufficiently. The surgeon then looks for any leaks in the new heart. 

Patients with serious heart conditions which may lead to heart failure are the perfect candidates for a heart transplant surgery. Heart transplant is an option only if all other treatment options have been tried and failed. Heart failure can have many causes, some of them being:

       Heart Valve Disease

       Cardiomyopathy

       Coronary Artery Disease

       Amyloidosis

       Congenital heart defects/disease

       Hemochromatosis

 

An ideal candidate for heart transplant is one who is:

       below the age of seventy

       devoid of other treatment options for the heart condition

       likely to die without the benefit of a heart transplant

       having general good health without other debilitating illnesses

       is ready to make the lifestyle changes that a transplantation demands

       having the financial, familial and social support for post-transplant care

 

A heart transplant is not attempted on those who have:

       irreversible kidney, lung, liver or nerve diseases

       a history of cancer or malignant tumours.

       an inability or unwillingness to follow a lifelong care plan after a transplant

       pulmonary hypertension (high blood pressure in the lungs) that can't be reversed

       active infection throughout the body

       diabetes related damage to major organs

       had a severe stroke or dementia

A person needs to make a lot of lifestyle adjustments after a heart transplant. Hence any person prone to tobacco or alcohol abuse is excluded. Similarly, anyone who is unable to take up the prescribed post-transplant care is also excluded. Also, a person undergoing transplant should have the financial resources to buy the expensive anti-rejection medicines for the rest of his life

 

Although a heart transplant surgery is a life saver, it is fraught with a lot of risks. The major risks of a heart transplant are:

Failure of the donor heart – Our immune system is always working towards eliminating foreign objects from our body. One of the biggest risk of a heart transplant surgery is the rejection of the new heart by the recipient’s body. The recipient’s immune system may try to attack the new heart. All people who receive a heart transplant surgery will need to take immunosuppressants to ‘trick’ the body into accepting the new heart, by lowering the immune system. However, for ten percent of these recipients, the new heart may still get rejected, and they will require additional treatment within the first year.

Complications from medicines – Heart transplant patients will need to take immunosuppressants for the rest of their lives. These immunosuppressants can cause kidney damage and other organ issues. Suppressing the immune system of the body can also make the patient vulnerable to getting frequent infections. Apart from this, these medications can also cause high blood pressure, diabetes or high cholesterol.

Complications due to inappropriate post-transplant care - Post-transplant care can significantly affect the patient’s ability to recover. The success of the heart transplant depends on long-term post-transplant care and if patient is unable to do so, then various complications may arise. Patients will need to make significant changes to their lifestyle and these changes will have to be maintained lifelong, if they wish to enjoy their new heart for a long duration.

Coronary Artery Problems - Occasionally, right after the heart transplant surgery, the walls of the arteries in the heart could harden, causing a disruption in the flow of blood and this may cause a heart attack, heart failure or a cardiac arrest.

Apart from these, heart transplant surgery also comes with the usual risks associated with every major surgery.

       Bleeding from the incision

       Bleeding during the surgery

       Negative reaction to anaesthesia

       Blood clots

       Death

Heart Transplant Recovery:

In the hospital- 

       The hospital stay will be in the range of three to four weeks

       The patient will be shifted to the ICU soon after surgery

       Ventilator support will be provided till the patient is able to breathe by themselves 

       Vital signs will be closely monitored

       Once the patient is removed from the ventilator, he/she is instructed to cough gently and periodically to prevent mucous from collecting in the lungs

       Pain medicines are administered to relieve the pain

       A biopsy of the transplanted heart is performed to look for signs of rejection.

       Blood samples will be taken often to monitor your new heart, as well as other body functions. 

       Physical therapy and breathing exercises are taught to get the body back to normal

At home-

Once the recipient reaches home, he should strictly follow the prescribed rehabilitation programme. Any untoward occurrence should be immediately reported to the doctor. Family support is crucial at the initial stages. The immediate family members should look for any changes in the recipient’s health condition. Visitors should be strictly restricted to prevent infections. The room should be kept as sterile as possible.

For the transplanted heart to function effectively in the body, one needs to take medicines for the rest of his life to fight rejection. The side effects can be serious and may differ from person to person. Adequate precautions need to be taken to prevent the side effects of the medicine. 

Routine heart biopsies will be done to watch for signs of rejection. The frequency of biopsy will reduce from once a week to once a month and will eventually stop. 

Dos and don’ts after surgery:

       Keep the surgical area clean and dry 

       Follow the specific bathing instructions 

       Lookout for signs of infection or rejection 

       Do not drive until permitted 

       Do not carry heavy objects

       Symptoms like breathing trouble, severe pain, fatigue, low blood pressure should be dealt with on emergency basis

       Regular dental care is important to prevent infections

       Avoid crowded places 

Heart transplant surgery is a major surgery and involves two surgeries – the surgery to remove the heart from the brain-dead donor and the transplant surgery on the recipient.

Heart transplant surgery, on an average, would cost between 42,000 to 45,000 USD in India. 

The factors which can influence this pricing are:

     ·       The duration of the stay in the hospital

     ·       The type of room selected – shared or private or deluxe

     ·       The hospital selected

     ·       The city where the surgery will take place – this will influence the additional costs such as airfare, stay for the recipient’s travelling partner(s) etc.

Cost (USD) Days in Hospital Days in India
55,000 - 80,000 30 - 45 45 - 60

Heart transplant surgery is a procedure where a healthy heart from a brain-dead person is transplanted to a recipient suffering from end stage heart disease. A transplant surgery is recommended only when other conventional methods to treat an end stage heart disease have failed completely. Heart transplant surgery is a very risky procedure that should be attempted only when the intended recipient has but a short time to live with his original heart.

A heart transplant surgery is possible only when a donor heart is available. Also, the donor heart should be an ideal match for the recipient. Since a donor heart is rare to get and recipients are more in number, an enrolment into a national organ registry is essential to be on a waiting list.

Not everyone can be a candidate for a heart transplant. In order to get a heart transplant, the recipient must be on a transplant list. However, even before the patient can be placed on a transplant list, they will need to go through a stringent evaluation process.

The transplant evaluation process includes:

       Psychological and social evaluation:  An assessment of the recipient’s social, psychological and financial status is done. The aim is to ensure that the patient has the ability to withstand all types of stress involved.

       Blood tests: A battery of blood tests is performed to ensure the compatibility of the recipient and the donor.

       Diagnostic tests: Various diagnostic and function tests are performed to ensure the status of the vital organs. These tests may include X-rays, ultrasound procedures, CT scan and MRIs if necessary. Pulmonary, kidney and liver function tests are also done.  Women are subjected to a Pap test, gynaecologic evaluation and a mammogram.

       Administration of vaccines: Various vaccines are administered to decrease the chances of developing infections that can affect the transplanted heart.

 

Things To Be Done Before A Transplant:

       The patient needs to be explained clearly what will happen during the surgery and the risks.

       Patient will need to sign a consent form

       Patient will need to fast before the surgery

       Detailed arrangements will be made based on the health of the recipient

 

The Heart Transplant Team Includes:

       Cardiologists

       Transplant surgeons

       Cardiac nurses

       Dieticians/Nutritionists

       Physiologists

       Social Workers

       Researchers

       Pharmacists

 

The Procedure:

Once a donor heart becomes available the surgeon at the transplant center removes the heart from the donor's body. The donor heart will be preserved in a specially cooled solution while being taken to the recipient.  At the same time the transplant surgeon will start preparing the recipient to receive the donor heart.

A large incision is made in the centre of the recipient’s chest to expose the ribs. The recipient’s ribs are then removed to expose the heart. The recipient will be put on a heart-lung machine as the first step of the surgery. The machine takes over the responsibilities of the heart during surgery. The recipient’s heart is then removed except for the back walls of the atria or the hearts upper chambers. Then the back walls of the atria of the donor heart are opened. The donor heart is then sutured to the atrial walls of the recipient. The blood vessels to the heart are then reconnected to the new heart to allow the normal flow of blood. The new heart starts beating once it warms up sufficiently. The surgeon then looks for any leaks in the new heart. 

Patients with serious heart conditions which may lead to heart failure are the perfect candidates for a heart transplant surgery. Heart transplant is an option only if all other treatment options have been tried and failed. Heart failure can have many causes, some of them being:

       Heart Valve Disease

       Cardiomyopathy

       Coronary Artery Disease

       Amyloidosis

       Congenital heart defects/disease

       Hemochromatosis

 

An ideal candidate for heart transplant is one who is:

       below the age of seventy

       devoid of other treatment options for the heart condition

       likely to die without the benefit of a heart transplant

       having general good health without other debilitating illnesses

       is ready to make the lifestyle changes that a transplantation demands

       having the financial, familial and social support for post-transplant care

 

A heart transplant is not attempted on those who have:

       irreversible kidney, lung, liver or nerve diseases

       a history of cancer or malignant tumours.

       an inability or unwillingness to follow a lifelong care plan after a transplant

       pulmonary hypertension (high blood pressure in the lungs) that can't be reversed

       active infection throughout the body

       diabetes related damage to major organs

       had a severe stroke or dementia

A person needs to make a lot of lifestyle adjustments after a heart transplant. Hence any person prone to tobacco or alcohol abuse is excluded. Similarly, anyone who is unable to take up the prescribed post-transplant care is also excluded. Also, a person undergoing transplant should have the financial resources to buy the expensive anti-rejection medicines for the rest of his life

 

Although a heart transplant surgery is a life saver, it is fraught with a lot of risks. The major risks of a heart transplant are:

Failure of the donor heart – Our immune system is always working towards eliminating foreign objects from our body. One of the biggest risk of a heart transplant surgery is the rejection of the new heart by the recipient’s body. The recipient’s immune system may try to attack the new heart. All people who receive a heart transplant surgery will need to take immunosuppressants to ‘trick’ the body into accepting the new heart, by lowering the immune system. However, for ten percent of these recipients, the new heart may still get rejected, and they will require additional treatment within the first year.

Complications from medicines – Heart transplant patients will need to take immunosuppressants for the rest of their lives. These immunosuppressants can cause kidney damage and other organ issues. Suppressing the immune system of the body can also make the patient vulnerable to getting frequent infections. Apart from this, these medications can also cause high blood pressure, diabetes or high cholesterol.

Complications due to inappropriate post-transplant care - Post-transplant care can significantly affect the patient’s ability to recover. The success of the heart transplant depends on long-term post-transplant care and if patient is unable to do so, then various complications may arise. Patients will need to make significant changes to their lifestyle and these changes will have to be maintained lifelong, if they wish to enjoy their new heart for a long duration.

Coronary Artery Problems - Occasionally, right after the heart transplant surgery, the walls of the arteries in the heart could harden, causing a disruption in the flow of blood and this may cause a heart attack, heart failure or a cardiac arrest.

Apart from these, heart transplant surgery also comes with the usual risks associated with every major surgery.

       Bleeding from the incision

       Bleeding during the surgery

       Negative reaction to anaesthesia

       Blood clots

       Death

Heart Transplant Recovery:

In the hospital- 

       The hospital stay will be in the range of three to four weeks

       The patient will be shifted to the ICU soon after surgery

       Ventilator support will be provided till the patient is able to breathe by themselves 

       Vital signs will be closely monitored

       Once the patient is removed from the ventilator, he/she is instructed to cough gently and periodically to prevent mucous from collecting in the lungs

       Pain medicines are administered to relieve the pain

       A biopsy of the transplanted heart is performed to look for signs of rejection.

       Blood samples will be taken often to monitor your new heart, as well as other body functions. 

       Physical therapy and breathing exercises are taught to get the body back to normal

At home-

Once the recipient reaches home, he should strictly follow the prescribed rehabilitation programme. Any untoward occurrence should be immediately reported to the doctor. Family support is crucial at the initial stages. The immediate family members should look for any changes in the recipient’s health condition. Visitors should be strictly restricted to prevent infections. The room should be kept as sterile as possible.

For the transplanted heart to function effectively in the body, one needs to take medicines for the rest of his life to fight rejection. The side effects can be serious and may differ from person to person. Adequate precautions need to be taken to prevent the side effects of the medicine. 

Routine heart biopsies will be done to watch for signs of rejection. The frequency of biopsy will reduce from once a week to once a month and will eventually stop. 

Dos and don’ts after surgery:

       Keep the surgical area clean and dry 

       Follow the specific bathing instructions 

       Lookout for signs of infection or rejection 

       Do not drive until permitted 

       Do not carry heavy objects

       Symptoms like breathing trouble, severe pain, fatigue, low blood pressure should be dealt with on emergency basis

       Regular dental care is important to prevent infections

       Avoid crowded places 

Heart transplant surgery is a major surgery and involves two surgeries – the surgery to remove the heart from the brain-dead donor and the transplant surgery on the recipient.

Heart transplant surgery, on an average, would cost between 42,000 to 45,000 USD in India. 

The factors which can influence this pricing are:

     ·       The duration of the stay in the hospital

     ·       The type of room selected – shared or private or deluxe

     ·       The hospital selected

     ·       The city where the surgery will take place – this will influence the additional costs such as airfare, stay for the recipient’s travelling partner(s) etc.