Overview of Heart Transplantation Patient Selection
Heart failure (HF), or when the heart does not pump blood as effectively as it should, is a major health issue both in the United States and globally. Its prognosis is only marginally better than pancreatic cancer. Millions are affected by this condition every year. Right now, over 5 million individuals live with a diagnosis of heart failure, and it’s predicted that the number will continue to grow. Severe (stage D) heart failure afflicts more than 10% of those dealing with heart failure.
If a person’s heart failure becomes very severe, a heart transplant could be the only solution for improving their quality of life and chances of survival. However, not everyone needing a heart transplant meets the necessary criteria to receive one. The process involves carefully choosing suitable patients based on certain requirements and the presence of conditions that might make the procedure risky. Health professionals will need to thoroughly evaluate and prepare the patient for the procedure, given its significant medical implications.
Why do People Need Heart Transplantation Patient Selection
Heart transplant surgery may be necessary for several reasons. Most importantly, it’s a treatment for people suffering from severe heart failure that can’t be helped with other medical or surgical treatments. About 10-15% of people with heart failure qualify for this type of surgery, although less than half of them get referred for the transplant evaluation. So, it’s crucial to know more about when a heart transplant might be needed.
Severe heart failure or end-stage heart disease, where the heart’s main left chamber is pumping out less than 20% of the blood it receives, is one of the key situations for considering a heart transplant. The condition becomes even more serious when the heart is unable to supply enough oxygen to the body, less than 12 milliliters per kilogram of body weight per minute.
Another reason for considering a heart transplant is cardiogenic shock. This is a serious condition where the heart suddenly can’t pump enough blood to meet your body’s needs. This often demands constant medication delivered directly into a vein or the use of medical devices to support the heart’s function, such as an intra-aortic balloon pump or a left ventricular assist device (LVAD).
A heart transplant may also be needed if someone has chest pain or heart disease caused by narrowing or blocking of the arteries, and this can’t be rectified with medical treatments, surgical procedures or devices that create a new path for blood flow around the blocked arteries.
Lastly, if a person has life-threatening irregular heartbeats that can’t be controlled with medication, procedures to disrupt the abnormal electrical pathways in the heart, or by implanting a device to monitor heart rhythm and deliver electric shocks when necessary, a heart transplant may be needed.
When a Person Should Avoid Heart Transplantation Patient Selection
There are specific conditions that might prevent someone from being eligible for a heart transplant. For instance, if someone’s estimated life expectancy is less than two years even with a new heart, they may not qualify for this procedure. This could be due to a range of diseases that can worsen quickly, such as AIDS (with regular severe infections), serious lung diseases that cause difficulty in breathing, cancer (diagnosed within the last 5 years), or incurable illnesses like lupus, sarcoidosis, or amyloidosis. Serious damage to the kidneys or liver, or extreme high blood pressure in the lungs can also be barriers to heart transplantation.
Additionally, there are conditions that don’t necessarily prevent someone from getting a heart transplant but may cause doctors to approach the procedure with caution. These include severe obesity or being underweight, problems with the kidneys or liver, a propensity for stomach ulcers, unmanaged diabetes or high blood pressure, problems with the blood vessels in the brain or extremities (“vascular disease”), irremediable disorders of the nervous or muscular systems, a recent history of low platelet count due to a reaction to the blood thinner heparin (“heparin-induced thrombocytopenia”), severe lung problems, a recent pulmonary infarct (a blockage in the blood vessels of the lungs), mental instability, or any substance misuse including drugs, tobacco, or alcohol in the past 6 months. Being older than 72 is also considered a factor, but this is sometimes disputed. Indeed, certain studies demonstrate that age doesn’t always determine the successful outcome of a heart transplant and it should be assessed on personalized case-to-case instances.
Who is needed to perform Heart Transplantation Patient Selection?
Caring for someone with heart failure requires a bunch of different medical experts. Your main heart doctor, or cardiologist, is usually at the head of this team. There might also be a special type of heart doctor and nurse who focus specifically on advanced heart failure. These experts have extra training to manage and treat severe cases.
A cardiovascular pharmacist, who understands medication related to heart diseases, helps to manage your medications and make sure they are working as they should. Also on the team might be a cardiac rehabilitation specialist who can help you regain strength and wellness through a medically supervised program especially designed for heart patients. There are also nurses and doctors who specialize in palliative care. These professionals focus on providing relief from the symptoms and stress of your illness and can also help arrange homecare or nursing home care if needed.
On the mental health side, a clinical psychologist or a psychiatrist may be on your team. These professionals can offer tools and techniques to help you cope with the emotional side of dealing with your illness. Lastly, your Primary care doctor will also play a key role in your team to help track your overall health and coordinate with your heart specialists. This ensures you get the best personalized treatment for your condition.
Preparing for Heart Transplantation Patient Selection
The process of a heart transplant is a complex and lengthy procedure. It involves a number of important steps that start with recognizing that a patient with significant heart failure needs a heart transplant now or in the future. This is the most critical part of the process. Once a transplant need is identified, the next step is to quickly send a referral to a heart transplant center. Prior to the transplant appointment, it is crucial for patients to start a special type of medical treatment called goal-directed medical therapy.
Once the patient arrives at the transplant center, a series of evaluations begin. These include checking the seriousness of the patient’s heart failure, looking for any factors that could be improved or reversed, and checking how effective their current medications are. Certain heart conditions, like diseases of the heart valves or diseases caused by blocked heart arteries, require additional testing. The doctors also check for rhythm problems in the heart and treat them accordingly.
It’s important for heart transplant candidates to steer clear of alcohol, drugs and over-the-counter painkillers that could make their heart condition worse. Although mental health issues, like anxiety and depression, are often taken into account when deciding on heart transplant suitability, research shows these conditions don’t impact the outcome of a heart transplant. As such, patients with mild mental health conditions should not necessarily be excluded from being considered for a heart transplant.
If a patient arrives at the hospital in a state of cardiogenic shock, with a failing heart that is causing other organs in their body to fail, the options are limited. These patients may need to urgently receive a heart transplant, mechanical heart device, or perhaps make the choice between palliative care and hospice. For patients who are doing better, a detailed evaluation is necessary to estimate the need for an urgent heart transplant.
What Else Should I Know About Heart Transplantation Patient Selection?
Heart transplantation can help a person live up to 10 years longer or more. This potential for a longer life makes the process of choosing who gets a heart transplant very important. The criteria used to decide who needs a heart transplant play a critical role in this decision process. This ensures all eligible patients are identified and referred for a heart transplant.
For doctors treating heart failure (both heart specialists and general practitioners), it’s vital to know when a patient needs a heart transplant. Spotting the need for a transplant early can lead to a faster evaluation and quicker placement on the transplant list.
