Heart-lung transplant
Encyclopedia
A heart–lung transplant is a procedure carried out to replace both heart
and lungs in a single operation. Due to a shortage of suitable donors, it is a rare procedure; only about a hundred such transplants are performed each year in the USA.
(UNOS) in the USA, of which around forty will die before a suitable donor is found.
Conditions which may necessitate a heart–lung transplant include:
Candidates for a heart–lung transplant are usually required to be:
laid the groundwork for heart lung transplantation with his experiments into heart transplantation at Stanford in the mid 1960s. Shumway conducted the first adult heart transplant in the US in 1968.
Building on his research at Stanford, Dr. Bruce Reitz
performed the first successful heart–lung transplant on Mary Gohlke in 1981 at Stanford Hospital. The transplant team at Stanford is the longest continuously active team performing these transplants.
. When the donor organs arrive, they are checked for fitness; if any organs show signs of damage, they are discarded and the operation cancelled. Some patients are concerned that their organs will be removed and the donor organs won't be suitable. Since this is a possibility, it is standard procedure that the patient is not operated on until the donor organs arrive and are judged suitable, despite the time delay this involves.
Once suitable donor organs are present, the surgeon
makes an incision starting above and finishing below the sternum, cutting all the way to the bone. The skin edges are retracted to expose the sternum. Using a bone saw, the sternum is cut down the middle. Rib spreaders are inserted in the cut, and spread the ribs to give access to the heart and lungs of the patient.
The patient is connected to a heart–lung machine, which circulates and oxygenates blood. The surgeon removes the failing heart and lungs. Most surgeons endeavour to cut blood vessels as close as possible to the heart to leave room for trimming, especially if the donor heart is of a different size than the original organ.
The donor heart and lungs are positioned and sewn into place. As the donor organs warm up to body temperature, the lungs begin to inflate. The heart may fibrillate
at first – this occurs because the cardiac muscle
fibres are not contracting synchronously. Internal paddles can be used to apply a small electric shock to the heart to restore proper rhythm.
Once the donor organs are functioning normally, the heart–lung machine is withdrawn, and the chest is closed.
, rejection
), some are able to return home after just two weeks in hospital. Patients will be given anti-rejection drugs
, and antibiotics to prevent infection. A schedule of frequent follow up visits is necessary.
states that the survival rate is now around 85%, one year after the transplant was performed.
In 2004, there were only 39 heart–lung transplants performed in the entire United States and only 75 worldwide. By comparison, in that same year there were 2,016 heart and 1,173 lung transplants.
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
and lungs in a single operation. Due to a shortage of suitable donors, it is a rare procedure; only about a hundred such transplants are performed each year in the USA.
Qualifying conditions
Most candidates for heart–lung transplants have life-threatening damage to both their heart and lungs. In the US, most prospective candidates have between twelve and twenty-four months to live. At any one time, there are about 250 people registered for heart–lung transplantation at the United Network for Organ SharingUnited Network for Organ Sharing
Located in Richmond, Virginia, the United Network for Organ Sharing is a non-profit, scientific and educational organization that administers the only Organ Procurement and Transplantation Network in the United States, established by the U.S. Congress in 1984.UNOS was awarded the initial OPTN...
(UNOS) in the USA, of which around forty will die before a suitable donor is found.
Conditions which may necessitate a heart–lung transplant include:
- Congenital problems (defects present at birth) affecting the heart and lungs (48%);
- Pulmonary hypertensionPulmonary hypertensionIn medicine, pulmonary hypertension is an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, and other symptoms, all of which are exacerbated by exertion...
(20%); - Cystic fibrosisCystic fibrosisCystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...
(2%); - A second transplant after the first transplant was rejected or failed to operate satisfactorily (4%).
Candidates for a heart–lung transplant are usually required to be:
- Under 55 years old;
- Have no other medical conditions (e.g. AIDSAIDSAcquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
, Diabetes, HepatitisHepatitisHepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
); - Mentally sound;
- Capable of following a post-operative regimen of exercise and immunosuppressantImmunosuppressantAn immunosuppressant is any substance that performs immunosuppression of the immune system. They may be either exogenous, as immunosuppressive drugs, or endogenous, as ,e. g., testosterone...
drugs.
History
Dr. Norman ShumwayNorman Shumway
Norman Edward Shumway was a pioneer of heart surgery at Stanford University.-Early life:Shumway was born in Kalamazoo, Michigan...
laid the groundwork for heart lung transplantation with his experiments into heart transplantation at Stanford in the mid 1960s. Shumway conducted the first adult heart transplant in the US in 1968.
Building on his research at Stanford, Dr. Bruce Reitz
Bruce Reitz
Bruce Reitz is a Board Certified Cardiothoracic Surgeon. Reitz is one of the foremost cardiac surgeons in the world and, during his term as chairman of the Department of Cardiothoracic surgery, he played a major role in keeping Stanford at the forefront of education, research and patient care in...
performed the first successful heart–lung transplant on Mary Gohlke in 1981 at Stanford Hospital. The transplant team at Stanford is the longest continuously active team performing these transplants.
Procedure
The patient is anesthetisedAnesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
. When the donor organs arrive, they are checked for fitness; if any organs show signs of damage, they are discarded and the operation cancelled. Some patients are concerned that their organs will be removed and the donor organs won't be suitable. Since this is a possibility, it is standard procedure that the patient is not operated on until the donor organs arrive and are judged suitable, despite the time delay this involves.
Once suitable donor organs are present, the surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
makes an incision starting above and finishing below the sternum, cutting all the way to the bone. The skin edges are retracted to expose the sternum. Using a bone saw, the sternum is cut down the middle. Rib spreaders are inserted in the cut, and spread the ribs to give access to the heart and lungs of the patient.
The patient is connected to a heart–lung machine, which circulates and oxygenates blood. The surgeon removes the failing heart and lungs. Most surgeons endeavour to cut blood vessels as close as possible to the heart to leave room for trimming, especially if the donor heart is of a different size than the original organ.
The donor heart and lungs are positioned and sewn into place. As the donor organs warm up to body temperature, the lungs begin to inflate. The heart may fibrillate
Fibrillation
Fibrillation is the rapid, irregular, and unsynchronized contraction of muscle fibers. An important occurrence is with regards to the heart.-Cardiology:There are two major classes of cardiac fibrillation: atrial fibrillation and ventricular fibrillation....
at first – this occurs because the cardiac muscle
Cardiac muscle
Cardiac muscle is a type of involuntary striated muscle found in the walls and histologic foundation of the heart, specifically the myocardium. Cardiac muscle is one of three major types of muscle, the others being skeletal and smooth muscle...
fibres are not contracting synchronously. Internal paddles can be used to apply a small electric shock to the heart to restore proper rhythm.
Once the donor organs are functioning normally, the heart–lung machine is withdrawn, and the chest is closed.
Post-operation
Most patients spend several days in intensive care after the operation. If there are no complications (e.g. infectionInfection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
, rejection
Transplant rejection
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after...
), some are able to return home after just two weeks in hospital. Patients will be given anti-rejection drugs
Immunosuppressive drug
Immunosuppressive drugs or immunosuppressive agents are drugs that inhibit or prevent activity of the immune system. They are used in immunosuppressive therapy to:...
, and antibiotics to prevent infection. A schedule of frequent follow up visits is necessary.
Statistics
The success rate of heart–lung transplants has improved a lot in recent years. The British National Health ServiceNational Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
states that the survival rate is now around 85%, one year after the transplant was performed.
In 2004, there were only 39 heart–lung transplants performed in the entire United States and only 75 worldwide. By comparison, in that same year there were 2,016 heart and 1,173 lung transplants.