Cardiac transplant

A surgical procedure in which a diseased heart is replaced with a healthy heart from a deceased person. The world’s first heart transplant was done on December 3, 1967 by South African surgeon Christiaan Bernard (1922-2001). The recipient was Louis Washkansky, a grocer. The surgery went well. However, Mr. Washkansky was left vulnerable to infection from the large doses of immune-suppressing drugs (azathioprine and hydrocortisone) and radiation he received. He died of pneumonia 18 days after surgery. The second human heart transplant was also done by Dr. Barnard. On Jan. 2, 1968, Dr. Barnard transplanted the heart of a young man into a retired dentist, Philip Blaiberg. (The young man was of "mixed race" while Dr. Blaiberg was white. The fact that Dr. Bernard ignored racial barriers caused a sensation in apartheid South Africa.) The amount of antirejection drugs was reduced and Dr. Blaiberg survived for 19 months and 15 days. He died of chronic organ rejection. Heart transplant surgery has now become a standard procedure. It had been done about 100,000 times as of 2001 and was carried out on about 2,100 patients in 160 hospitals in the U.S. in 2001, with a one-year success rate of 85-90% and a five-year success rate of 75%. There have been two main barriers to successful heart transplants. The first barrier has been rejection of the donor heart by the patient, as occurred in the case of Dr. Blaiberg. Cyclosporine, which was introduced in 1983, and other medications to control rejection have greatly improved the survival of transplant patients. The second barrier to increasing the number of successful transplantations continues to be the availability of donor hearts. Donors are individuals who are brain dead, meaning that the brain shows no signs of life while the person's body is being kept alive by a machine. Donors may have died in an automobile accident or from a stroke, a gunshot wound, suicide, or a head injury. Most hearts come from those who die before age 45. Donor organs are located in the U.S. through the United Network for Organ Sharing (UNOS). Not enough organs are available for transplant. A patient may wait months for a transplant. More than 25% do not live long enough. The donor heart is completely removed and quickly transported to the patient, who may be located at some considerable distance. The heart is cooled and kept in a special solution while being taken to the patient. During the operation, the patient is placed on a heart-lung machine which allows bypass of blood flow to the heart and lungs. The machine pumps the blood throughout the rest of the body, removing carbon dioxide and replacing it with oxygen needed by body tissues. The patient's heart is removed except for the back walls of the atria, the heart's upper chambers. The backs of the atria on the new heart are opened and the heart is sewn into place. Surgeons then connect the blood vessels and allow blood to flow through the heart and lungs. As the heart warms up, it begins beating. Patients are usually up and around a few days after surgery and, if there are no signs of the body immediately rejecting the heart, are home within 2 weeks.