Overview of Heart Transplantation Patient Selection
Heart failure, often referred to as HF, is a serious health condition that affects millions of people across the globe. In the United States alone, over 5 million people are living with it. It’s a leading cause of sickness and death and is only outpaced by pancreatic cancer in regards to having the shortest life expectancy. The problem with heart failure is that it is expected to affect even more people in the future.
Of those with heart failure, more than 10% have advanced or stage D disease. This is the most serious phase of the condition. When a person reaches this stage, a heart transplant is typically the only option capable of improving their quality of life and chances of survival. However, not everyone who needs a heart transplant can or will qualify to receive one.
We’re going to provide more information about who might qualify for a heart transplant and who might not. We’ll also discuss the process of patient selection for a heart transplant, what types of medical professionals are involved in the decision-making process, and what to expect if you or a loved one is getting ready to undergo this potentially life-saving procedure.
Why do People Need Heart Transplantation Patient Selection
Heart transplant can be a life-saving procedure for individuals facing severe heart health issues. Approximately 10-15% of patients suffering from heart failure match the criteria for this major surgery. However, less than half of these are referred for a transplant analysis. Thus, it’s vital to understand the conditions in which a heart transplant is necessary.
A heart transplant becomes a priority if the patient’s heart disease has reached an extreme level and can’t be addressed with regular medical or surgical treatments. Extreme heart disease often means the heart’s left pumping chamber, the left ventricle, is only able to pump out less than 20% of the blood it receives, and the body can only consume less than 12 mL of oxygen/kg body weight per minute during exercise.
If a person’s heart is so weak that they need constant drug-based support to push their heart to pump properly, or if they require mechanical devices like a balloon pump or a left ventricular assist device (LVAD) to help their heart pump blood, this is a clear sign that a heart transplant may be necessary.
Other conditions that might call for a heart transplant include persistent chest pain symptoms due to blood flow issues that can’t be resolved with medication-based treatments or surgical interventions. Additionally, deadly abnormal heart rhythms that don’t respond to medical treatments, catheter ablation (a procedure to remove the heart tissue causing the abnormal rhythm), or the implantation of a device to control the heart’s rhythm can also point to a heart transplant being needed.
When a Person Should Avoid Heart Transplantation Patient Selection
Receiving a heart transplant may not be possible for everyone due to certain conditions or exclusions. For instance, people who are expected to live less than two years even with a new heart are generally not eligible. Diseases that can shorten life expectancy to less than two years include AIDS with frequent infections, severe lung disease, cancer within the past five years, and uncurable illnesses such as amyloidosis, sarcoidosis, or lupus. Also, irreversible kidney and liver disease, and fixed high blood pressure in the lungs, can make a transplant too dangerous.
There are also other conditions that need careful consideration before a transplant. These include obesity, severe eating disorders, kidney or liver issues, peptic ulcer disease, diabetes or high blood pressure that is hard to control, certain types of severe blood vessel diseases, irreversible brain or muscle disorders, and a bad reaction to the blood-thinner heparin within the last 100 days. People with severe lung disease or a lung clot within the last two months, mental instability, or who have used drugs, tobacco, or alcohol within the last six months, may also be deemed unfit for the procedure. Being older than 72 is also generally seen as a risk, but this is a controversial topic as some studies have found great success with older patients.
Who is needed to perform Heart Transplantation Patient Selection?
When dealing with heart failure, you should have a dedicated team of healthcare professionals looking after you. Here’s what the group may look like:
Your main heart doctor, also known as a cardiologist, will be part of the team. There is also an advanced heart failure specialist who is a doctor with extra training in dealing with severe heart issues. An advanced heart failure nurse helps the doctors provide you with care. A cardiovascular pharmacist knows all about the different heart medications and can make sure you’re taking the right ones.
You may also work with a cardiac rehabilitation specialist who can help you exercise and regain strength in a safe way. A palliative care nurse and specialist are there to make sure you’re comfortable and support you in managing your symptoms. A psychologist and a psychiatrist will help you deal with any emotional or mental health concerns you may have because of your heart problems. Lastly, your usual doctor, your primary care physician, will also be involved in your care.
All of these people work together to ensure you’re as healthy as possible given your condition. They will all coordinate to give you the best care and help you manage your heart failure.
Preparing for Heart Transplantation Patient Selection
The process of receiving a heart transplant can feel complex and take a long time. It begins with a doctor understanding that a patient with severe heart failure may either now or in the future need a heart transplant. Recognizing this need is the first big step. Once this has been determined, the patient should be quickly referred to a heart transplant centre. In preparation for the heart transplant appointment, it’s essential for the patient to start a targeted treatment plan designed to manage their heart condition before the operation. This plan is typically in place for about 3 to 6 months before the heart transplant to see how the patient responds to the treatment.
When they arrive at the transplant center, a thorough check over the patient’s heart health will be made to understand how severe their heart failure is. The doctors will also check to see if there are any factors that they could potentially fix or cure, as well as evaluate how well the current treatment plan is working. They will perform tests for any issues related to the patient’s heart valves or diseases caused by a narrowing of the arteries in the heart. If the patient has problems with an irregular heartbeat, appropriate treatments such as medications, a procedure to restore regular rhythm, or even implanting a device to control the heartbeat might be required.
Patients are instructed to avoid alcohol, illegal drugs, medications that make the body hold onto salt, and pain relievers known as NSAID’s. It’s also important to note that having anxiety or depression doesn’t impact your eligibility for a heart transplant or the success of the transplant. However, on occasion, a patient’s mental health could influence whether they’re chosen for a heart transplant.
If a patient is experiencing severe heart failure symptoms or receiving medications through an IV to support their heart when they’re referred, their options might be to receive a heart transplant, use a mechanical device to support the heart, or consider comfort-focused treatment such as palliative care or hospice. For patients who aren’t as severely sick, doctors will gather important information to understand the patient’s outlook and determine whether they should be listed for a heart transplant. Patients shouldn’t worry if they have mild mental health concerns, as this doesn’t necessarily affect their chances to get a heart transplant.
What Else Should I Know About Heart Transplantation Patient Selection?
Having a heart transplant can potentially extend someone’s life by up to 10 years or even longer. Because of this life-changing benefit, it’s important that doctors select the right patients for this procedure. Knowing the appropriate selection criteria for a heart transplant can greatly influence a doctor’s decisions and ensure that all suitable patients are identified and correctly referred for this procedure.
It’s absolutely vital that doctors dealing with heart failure (both heart specialists and general practitioners) can recognize when a heart transplant is needed. Detecting the need for a heart transplant early on is crucial because it allows for a prompt assessment and placement on the transplant waiting list. This can have a big impact on the success of the transplant.