A heart transplant, or a cardiac transplant, is a

surgical Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

transplant procedure performed on patients with end-stage

heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, ...

or severe

coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic pl ...

when other medical or surgical treatments have failed. , the most common procedure is to take a functioning

heart The heart is a muscular Organ (biology), organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as ca ...

, with or without both lungs, from a recently deceased organ donor (

brain death Brain death is the permanent, irreversible, and complete loss of brain function which may include cessation of involuntary activity necessary to sustain life. It differs from persistent vegetative state, in which the person is alive and some aut ...

is the standard) and implant it into the patient. The patient's own heart is either removed and replaced with the donor heart ( orthotopic procedure) or, much less commonly, the recipient's diseased heart is left in place to support the donor heart (heterotopic, or "piggyback", transplant procedure). Approximately 3,500 heart transplants are performed each year worldwide, more than half of which are in the US. Post-operative survival periods average 15 years. Heart transplantation is not considered to be a cure for heart disease; rather it is a life-saving treatment intended to improve the quality and duration of life for a recipient.

History

American medical researcher Simon Flexner was one of the first people to mention the possibility of heart transplantation. In 1907, he wrote the paper "Tendencies in Pathology," in which he said that it would be possible one day by surgery to replace diseased human organs – including arteries, stomach,

kidneys The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; bloo ...

and heart. Not having a human donor heart available, James D. Hardy of the University of Mississippi Medical Center transplanted the heart of a chimpanzee into the chest of dying Boyd Rush in the early morning of Jan. 24, 1964. Hardy used a defibrillator to shock the heart to restart beating. This heart did beat in Rush's chest for 60 to 90 minutes (sources differ), and then Rush died without regaining consciousness.''Every Second Counts: The Race to Transplant the First Human Heart'', Donald McRae, New York: Penguin (Berkley/Putnam), 2006
Ch. 7 "Mississippi Gambling"
pp. 123–27. This source states the heartbeat for approximately one hour.
Obituary, ''New York Times'' (Associated Press), Feb. 21, 2003. This source states the transplanted chimpanzee heartbeat for 90 minutes. Although Hardy was a respected surgeon who had performed the world's first human-to-human lung transplant a year earlier, See also in same issue.Second Wind: Oral Histories of Lung Transplant Survivors
Mary Jo Festle, Palgrave MacMillan, 2012. author Donald McRae states that Hardy could feel the "icy disdain" from fellow surgeons at the Sixth International Transplantation Conference several weeks after this attempt with the chimpanzee heart.''Every Second Counts'', McRae
page 126, top
Hardy had been inspired by the limited success of

Keith Reemtsma Keith Reemtsma (5 December 1925 – 23 June 2000) was an American transplant surgeon, best known for the cross-species kidney transplantation operation from chimpanzee to human in 1964. With only the early immunosuppressants and no long-term ...

Tulane University Tulane University, officially the Tulane University of Louisiana, is a private research university in New Orleans, Louisiana. Founded as the Medical College of Louisiana in 1834 by seven young medical doctors, it turned into a comprehensive pub ...

in transplanting chimpanzee kidneys into human patients with kidney failure. ' … the consent form for Hardy's operationwhich, in view of the patient's semi-comatose condition, was signed by a close relativestipulated that no heart transplant had ever been performed, but made no mention of the fact that an animal heart might be used for the procedure. Such was the medicolegal situation at that time that this "informed" consent was not considered in any way inadequate. . ' The consent form Hardy asked Rush's stepsister to sign did not include the possibility that a chimpanzee heart might be used, although Hardy stated that he did include this in verbal discussions.''Xenotransplantation: Law and Ethics'', Sheila McLean, Laura Williamson, University of Glasgow, UK, Ashgate Publishing, 2005
p. 50
A

xenotransplantation Xenotransplantation (''xenos-'' from the Greek meaning "foreign" or strange), or heterologous transplant, is the transplantation of living cells, tissues or organs from one species to another. Such cells, tissues or organs are called xenograft ...

is the technical term for the transplant of an organ or tissue from one species to another. Dr Dhaniram Baruah of

Assam Assam (; ) is a state in northeastern India, south of the eastern Himalayas along the Brahmaputra and Barak River valleys. Assam covers an area of . The state is bordered by Bhutan and Arunachal Pradesh to the north; Nagaland and Manipur ...

, India was the first heart surgeon to transplant a pig's heart in human body. However the recipient died subsequently. The world's first successful pig-to-human heart transplant was performed in January 2022 by surgeon

Bartley P. Griffith Bartley P. Griffith (born 1949) is an American heart surgeon. Griffith is currently The Thomas E and Alice Marie Hales Distinguished Professor in Transplantation at the University of Maryland School of Medicine. He has been continuously funded ...

of USA. The world's first human-to-human heart transplant was performed by

South Africa South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring coun ...

n cardiac surgeon

Christiaan Barnard Christiaan Neethling Barnard (8 November 1922 – 2 September 2001) was a South African cardiac surgeon who performed the world's first human-to-human heart transplant operation. On 3 December 1967, Barnard transplanted the heart of accident-v ...

utilizing the techniques developed by American surgeons Norman Shumway and Richard Lower. McRae, D. (2006). ''Every Second Counts: The Race to Transplant the First Human Heart'', New York: Penguin (Berkley/Putnam). Patient Louis Washkansky received this transplant on December 3, 1967, at the Groote Schuur Hospital in

Cape Town Cape Town ( af, Kaapstad; , xh, iKapa) is one of South Africa's three capital cities, serving as the seat of the Parliament of South Africa. It is the legislative capital of the country, the oldest city in the country, and the second largest ...

, South Africa. Washkansky, however, died 18 days later from

pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severit ...

. On December 6, 1967, at Maimonides Hospital in Brooklyn, New York, Adrian Kantrowitz performed the world's first pediatric heart transplant. The infant's new heart stopped beating after 7 hours and could not be restarted. At a following press conference, Kantrowitz emphasized that he did not consider the operation a success.''Heart: An American Medical Odyssey'', Dick Cheney, Richard B. Cheney, Jonathan Reiner, MD, with Liz Cheney, Scribner (division of Simon & Schuster), 2013
"Three days later, on December 6, 1967, Dr. Adrian Kantrowitz"
/ref> Norman Shumway performed the first adult heart transplant in the United States on January 6, 1968, at the

Stanford University Hospital Stanford University Medical Center is a medical complex which includes Stanford Health Care and Stanford Children's Health. It is consistently ranked as one of the best hospitals in the United States and serves as a teaching hospital for the S ...

. A team led by Donald Ross performed the first heart transplant in the United Kingdom on May 3, 1968. These were allotransplants, the technical term for a transplant from a non-genetically identical individual of the same species.

Brain death Brain death is the permanent, irreversible, and complete loss of brain function which may include cessation of involuntary activity necessary to sustain life. It differs from persistent vegetative state, in which the person is alive and some aut ...

is the current ethical standard for when a heart donation can be allowed. Worldwide, more than 100 transplants were performed by various doctors during 1968. Only a third of these patients lived longer than three months.The Adrian Kantrowitz Papers, Replacing Hearts: Left Ventricle Assist Devices and Transplants, 1960–1970
National Institutes of Health, U.S. National Library of Medicine. The next big breakthrough came in 1983 when

cyclosporine Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is a natural product. It is taken orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease ...

entered widespread usage. This drug enabled much smaller amounts of

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are inv ...

s to be used to prevent many cases of rejection (the "corticosteroid-sparing" effect of cyclosporine).Transplantation of the heart: An overview of 40 years' clinical and research experience at Groote Schuur Hospital and the University of Cape Town
''South African Medical Journal'', "Part I. Surgical experience and clinical studies." J Hassoulas, Vol. 102, No. 6 (2012). On June 9, 1984, "JP" Lovette IV of

Denver Denver () is a consolidated city and county, the capital, and most populous city of the U.S. state of Colorado. Its population was 715,522 at the 2020 census, a 19.22% increase since 2010. It is the 19th-most populous city in the Unit ...

Colorado Colorado (, other variants) is a state in the Mountain West subregion of the Western United States. It encompasses most of the Southern Rocky Mountains, as well as the northeastern portion of the Colorado Plateau and the western edge of the ...

, became the world's first successful pediatric heart transplant. Columbia-Presbyterian Medical Center surgeons transplanted the heart of 4-year-old John Nathan Ford of Harlem into 4-year-old JP a day after the Harlem child died of injuries received in a fall from a fire escape at his home. JP was born with multiple heart defects. The transplant was done by a surgical team led by Dr. Eric A. Rose, director of cardiac transplantation at New York–Presbyterian Hospital. Drs. Keith Reemtsma and Fred Bowman also were members of the team for the six-hour operation. In 1988, the first "domino" heart transplant was performed, in which a patient in need of a lung transplant with a healthy heart will receive a heart-lung transplant, and their original heart will be transplanted into someone else. Worldwide, about 3,500 heart transplants are performed annually. The vast majority of these are performed in the United States (2,000–2,300 annually).

Cedars-Sinai Medical Center Cedars-Sinai Medical Center is a nonprofit, tertiary, 886-bed teaching hospital and multi-specialty academic health science center located in Los Angeles, California. Part of the Cedars-Sinai Health System, the hospital employs a staff of over ...

in Los Angeles, California, currently is the largest heart transplant center in the world, having performed 132 adult transplants in 2015 alone. About 800,000 people have NYHA Class IV heart failure symptoms indicating advanced heart failure. The great disparity between the number of patients needing transplants and the number of procedures being performed spurred research into the transplantation of non-human hearts into humans after 1993.

Xenograft Xenotransplantation (''xenos-'' from the Greek meaning "foreign" or strange), or heterologous transplant, is the transplantation of living cells, tissues or organs from one species to another. Such cells, tissues or organs are called xenograf ...

s from other species and

artificial heart An artificial heart is a device that replaces the heart. Artificial hearts are typically used to bridge the time to heart transplantation, or to permanently replace the heart in the case that a heart transplant (from a deceased human or, exper ...

s are two less successful alternatives to allografts. The ability of medical teams to perform transplants continues to expand. For example,

Sri Lanka Sri Lanka (, ; si, ශ්‍රී ලංකා, Śrī Laṅkā, translit-std=ISO (); ta, இலங்கை, Ilaṅkai, translit-std=ISO ()), formerly known as Ceylon and officially the Democratic Socialist Republic of Sri Lanka, is an ...

's first heart transplant was successfully performed at the Kandy General Hospital on July 7, 2017. In recent years, donor heart preservation has improved and Organ Care System is being used in some centers in order to reduce the harmful effect of cold storage. During heart transplant, the

vagus nerve The vagus nerve, also known as the tenth cranial nerve, cranial nerve X, or simply CN X, is a cranial nerve that interfaces with the parasympathetic control of the heart, lungs, and digestive tract. It comprises two nerves—the left and righ ...

is severed, thus removing

parasympathetic The parasympathetic nervous system (PSNS) is one of the three divisions of the autonomic nervous system, the others being the sympathetic nervous system and the enteric nervous system. The enteric nervous system is sometimes considered part of ...

influence over the

myocardium Cardiac muscle (also called heart muscle, myocardium, cardiomyocytes and cardiac myocytes) is one of three types of vertebrate muscle tissues, with the other two being skeletal muscle and smooth muscle. It is an involuntary, striated muscle tha ...

. However, some limited return of sympathetic nerves has been demonstrated in humans. Recently, Australian researchers found a way to give more time for a heart to survive prior to the transplant, almost double the time. On January 7, 2022, David Bennett, aged 57, of Maryland became the first person to receive a gene-edited pig heart in a transplant at the University of Maryland Medical Center. Before the transplant, David was unable to receive a human heart due to the patient's past conditions with heart failure and an irregular heartbeat, causing surgeons to use the pig heart that was genetically modified. Bennett died two months later at University of Maryland Medical Center on March 8, 2022.

Contraindications

Some patients are less suitable for a heart transplant, especially if they have other

circulatory The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, t ...

conditions related to their heart condition. The following conditions in a patient increase the chances of complications. Absolute contraindications: * Irreversible

kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...

lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of ...

, or

liver The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it i ...

disease * Active cancer if it is likely to impact the survival of the patient * Life-threatening diseases unrelated to the cause of

, including acute infection or systemic disease such as

systemic lupus erythematosus Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Commo ...

sarcoidosis Sarcoidosis (also known as ''Besnier-Boeck-Schaumann disease'') is a disease involving abnormal collections of inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph nodes. Less commonly af ...

, or

amyloidosis Amyloidosis is a group of diseases in which abnormal proteins, known as amyloid fibrils, build up in tissue. There are several non-specific and vague signs and symptoms associated with amyloidosis. These include fatigue, peripheral edema, weig ...

Vascular disease Vascular disease is a class of diseases of the blood vessels – the arteries and veins of the circulatory system of the body. Vascular disease is a subgroup of cardiovascular disease. Disorders in this vast network of blood vessels can cause a ...

of the neck and leg arteries. * High pulmonary vascular resistance – over 5 or 6 Wood units. Relative contraindications: *

Insulin Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the ''INS'' gene. It is considered to be the main anabolic hormone of the body. It regulates the metabolism ...

-dependent

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

with severe organ dysfunction * Recent

thromboembolism Thrombosis (from Ancient Greek "clotting") is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets ...

such as

stroke A stroke is a disease, medical condition in which poor cerebral circulation, blood flow to the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemorr ...

* Severe

obesity Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's ...

* Age over 65 years (some variation between centers) – older patients are usually evaluated on an individual basis. * Active

substance use disorder Substance use disorder (SUD) is the persistent use of drugs (including alcohol) despite substantial harm and adverse consequences as a result of their use. Substance use disorders are characterized by an array of mental/emotional, physical, and ...

, such as

alcohol Alcohol most commonly refers to: * Alcohol (chemistry), an organic compound in which a hydroxyl group is bound to a carbon atom * Alcohol (drug), an intoxicant found in alcoholic drinks Alcohol may also refer to: Chemicals * Ethanol, one of sev ...

, recreational drugs or

tobacco Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...

smoking (which increases the chance of lung disease) Patients who are in need of a heart transplant but do not qualify may be candidates for an

or a left ventricular assist device (LVAD).

Complications

Potential complications include: * Post-operative complications include infection,

sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...

. The surgery death rate was 5–10% in 2011. * Acute or chronic graft rejection :*

Cardiac allograft vasculopathy Cardiac allograft vasculopathy (CAV) is a progressive type of coronary artery disease in people who have had a heart transplant. As the donor heart has lost its nerve supply there is typically no chest pain, and CAV is usually detected on routin ...

* Atrial arrhythmia * Lymphoproliferative malignancy * Increased risk of secondary infections due to immunosuppressive medication * Serum sickness due to

anti-thymocyte globulin Anti-thymocyte globulin (ATG) is an infusion of horse or rabbit-derived antibodies against human T cells and their precursors (thymocytes), which is used in the prevention and treatment of acute rejection in organ transplantation and therapy of ...

* Tricuspid valve regurgitation Repeated endomyocardial biopsy can cause * Bleeding and thrombosis

Rejection

Since the transplanted heart originates from another organism, the recipient's immune system typically attempts to reject it. The risk of rejection never fully goes away, and the patient will be on immunosuppressive drugs for the rest of their life. These drugs may cause unwanted side effects, such as an increased likelihood of infections or the development of certain cancers. Recipients can acquire kidney disease from a heart transplant due to the side effects of immunosuppressant medications. Many recent advances in reducing complications due to tissue rejection stem from mouse heart transplant procedures. People who have had heart transplants are monitored in various ways to test for the development of rejection. A 2022 pilot study examining the acceptability and feasibility of using video directly observed therapy to increase medication adherence in adolescent heart transplant patients showed promising results of 90.1% medication adherence compared to 40-60% typically. Higher medication variability levels can lead to fewer organ rejections and other poor outcomes.

Prognosis

The prognosis for heart transplant patients following the orthotopic procedure has improved over the past 20 years, and as of June 5, 2009 the survival rates were:Heart Disease and Stroke Statistics – 2012 Update
''The

American Heart Association The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and deat ...

''. Retrieved 27 November 2012. * 1 year: 88.0% (males), 86.2% (females) * 3 years: 79.3% (males), 77.2% (females) * 5 years: 73.2% (males), 69.0% (females) In 2007, researchers from the Johns Hopkins University School of Medicine discovered that "men receiving female hearts had a 15% increase in the risk of adjusted cumulative mortality" over five years compared to men receiving male hearts. Survival rates for women did not significantly differ based on male or female donors.

References

External links

Orthotopic heart transplantation: the bicaval technique

Heart Treatments - Heart Treatments , NHLBI, NIH
NIH {{DEFAULTSORT:Heart Transplantation Cardiac surgery Organ transplantation