When I first saw this 40-year-old man, he could barely lie down without becoming breathless. Fluid had accumulated in his lungs and legs, and his heart was functioning at only 15–20%. Yet today, after a heart transplant, he is active and leading a near-normal life. His journey had begun just a year earlier, when he suffered a major heart attack at the age of 39. He underwent angioplasty, but his heart function never recovered. Over time, the damage from that heart attack progressed to severe heart failure. Despite medical treatment, his condition deteriorated, with increasing breathlessness and fluid accumulation. At that stage, a heart transplant became the best option. We evaluated him thoroughly before listing him for transplantation. This included blood tests, cardiac imaging and a cardiac catheterisation test to assess his heart and pulmonary pressures, as well as a detailed evaluation of his overall health. Once he was found suitable, we registered him on the heart-transplant waiting list. A heart transplant is a race against time A heart transplant is not simply a surgical procedure. It is a carefully coordinated logistical exercise in which every hour matters. When a potential donor is identified — often following a road crash or catastrophic brain injury — the donor is evaluated for organ donation. The heart can be retrieved only after death has been formally declared according to established medical and legal criteria, and after the necessary consent and other requirements are completed. Once a suitable heart is allocated, the transplant team may have to travel to another city, sometimes by air, to retrieve it. The donor heart is beating before retrieval, and after it is removed, there is only a limited preservation window to transport it and implant it in the recipient. Ideally, the entire process is completed within about four to six hours of retrieval, making coordination between the donor hospital, transplant team, transport authorities and recipient hospital critical. Blood-group compatibility is an important consideration, along with the recipient’s medical urgency and other factors used in organ allocation. The waiting period can vary considerably. Higher donor hearts in south Interestingly, in some southern states, there are situations where the number of suitable cadaveric donor hearts can exceed the number of registered recipients. As a result, a patient who is already registered and medically suitable may sometimes receive a heart within a month, although this depends on blood group, compatibility, urgency and organ availability. For our patient, once a suitable donor heart became available, the transplant was carried out. The operation took around four to six hours, followed by close monitoring in the intensive care unit. He remained in hospital for about 20 days. When does a patient need a heart transplant? Heart transplantation is considered when a patient has advanced or end-stage heart failure and other treatments are no longer able to control symptoms or provide an acceptable quality of life. The decision to list someone is not based on heart function alone. We look at symptoms, exercise capacity, hospital admissions, response to medicines and the functioning of other organs. A detailed pre-transplant assessment—including blood tests, imaging and cardiac catheterisation—is essential. Once a patient is accepted for transplantation, registration on the waiting list is a crucial step. A suitable donor heart is then allocated based on factors including blood group, medical urgency, compatibility and the applicable organ-allocation system. The results can be encouraging. Around 75% of heart-transplant recipients are alive 10 years after transplantation. More importantly, many patients who were previously unable to walk, work or even sleep lying flat can return to an active and meaningful life. Our patient is a good example. Today, he is physically active and has returned to a much more normal routine. A heart that had been severely damaged by a heart attack has effectively been replaced by a healthy donor heart, giving him a second chance at life. Life after a heart transplant A transplant does not mean the end of medical care. Patients require lifelong follow-up and immunosuppressive medicines to prevent rejection. The doses can often be reduced over time, depending on the individual patient and the transplant team’s assessment, but immunosuppression generally remains necessary. The first few months require particularly careful monitoring for rejection, infection and other complications. With regular follow-up, medication adherence and appropriate lifestyle changes, many recipients are able to resume remarkably active lives. What I find most rewarding about heart transplantation is seeing this transformation in quality of life. For patients whose heart failure has reached the stage where every other medical option has been exhausted, transplantation can offer something that medicines and procedures sometimes cannot. That’s reclaiming a life of dignity. (Dr Shetty is the lead cardiologist and medical director, Sparsh Hospital, Bengaluru)
