70% of the urban Indian population is at risk of being diagnosed with heart disease. Based on disease specific estimates of prevalence and incidence rates of heart failure, a conservative estimate of the prevalence of heart failure in India due to coronary artery disease, hypertension, diabetes and rheumatic heart disease ranges from 1.3 to 4.6 million, with an annual incidence of 491600-1.8 million.
A heart transplant involves replacing a diseased heart with a donor’s healthy heart. A heart transplant is considered when heart failure is so severe that it does not respond to any other therapy.
Heart failure is a condition when the pumping action of the heart is unable to supply the needs of the body. It can be sudden in onset (acute heart failure) or develop more slowly without the person knowing that anything is wrong( chronic heart failure).Causes for heart failure could include viral infections of the heart(myocarditis), post heart attack, narrowed valves or cardiomyopathies.
Once the heart starts malfunctioning, in time other organs deprived of a good circulation will start getting damaged as well. The lungs, kidneys, brain and liver are particularly vulnerable. Advanced heart failure has a 70-80% chance of death if untreated. This is worse than most cancers.
Most patients will require nothing more than medications, life style changes and close monitoring to ensure that they are stable. There are many new innovations in the treatment of heart failure, from new drugs to pacemakers and new surgical therapies.
In patients with severe heart failure that is unresponsive to therapy, treatment options fall into two categories- support with an artificial heart or replace with another heart (heart transplant)
Survival among heart transplant recipients has improved as a result of improvements in treatments that supress the immune system and prevent infection. Approximately 85 to 90 percent of heart transplant patients are living one year after their surgery, with an annual death rate of approximately 4 percent thereafter. The 3 year survival approaches 75%.
Living donor candidates should be: in good physical and mental health, free from high blood pressure, diabetes, cancer, HIV, hepatitis, or organ specific diseases, at least 18 years old and less than 55 years.
A good donor should also be willing to donate, be well informed, have good support in the decision to donate and have no alcohol or substance abuse problems.
Brain death is the total and irreversible loss of all brain function and the circumstance under which the donation of vital organs most commonly takes place.
The concept of brain death is often difficult for families to come to terms with when dealing with a tragic loss. Their loved one who has suffered from an injury to the brain is in a hospital intensive care unit. Doctors are doing everything possible to help the patient including supporting blood pressure and heart rate with medications, breathing for the patient with a ventilator, and constantly monitoring the patient’s condition. Often, for the patient with a non-traumatic brain injury like a stroke, there is no outward sign that their loved one has suffered a devastating and non-survivable injury to the brain. The patient looks to be asleep, is warm to touch and appears to breath, albeit with the help of a machine.
It is under these circumstances that families are asked to understand that their loved one has died. It is also under the same scenario that organ donation is presented as an option in order to give life to others.
Brain death occurs when a person has an irreversible, catastrophic brain injury, which causes total cessation of all brain function (the upper brain structure and brain stem). Brain death is not a coma or persistent vegetative state. A patient who is in a coma or persistent vegetative state typically has some brain stem function (which controls breathing) and possibly other brain function. When a person is brain dead, no part of the brain is functioning any longer.
When someone is brain dead, it means that the brain is no longer working in any capacity and never will again. Other organs, such as the heart, kidneys or liver, can still work for a short time if the breathing machine is left in place, but when brain death is declared, it means the person has died.
Death of the brain can occur from accidental injuries or illness. High blood pressure can also cause bleeding in the brain and result in death. A brain infection, a brain tumor or a traumatic injury may cause the brain to swell and lead to death as well.
Brain death is determined in the hospital by one or more physicians not associated with a transplantation team. Doctors examining the patient will conduct a battery of tests to determine whether any brain activity is present. If all brain activity is absent, the patient is dead.
The heart is part of the autonomic nervous system and thus has the ability to beat independently of the brain as long as it has oxygen. The heart will eventually stop beating as all bodily systems begin to stop working shortly after brain death. Once this process has begun, it cannot be reversed. At the time a physician declares brain death, the patient is dead. Mechanical support (a breathing machine) keeps oxygen going to the organs until they can be recovered for transplant. The machine is not keeping the patient alive (brain death is irreversible and is legally and medically recognized as death), it is merely keeping the organs viable until they can be recovered.
The Department of Cardiothoracic Surgery in KLES Dr.Prabhakar Kore Hospital has performed over 22,000 heart operations. It has a highly skilled, qualified and experienced team of surgeons, anaesthesiologists, cardiologists, perfusionists, operating room and intensive care nurses. We use state of the art operating rooms, ICU’S, equipment and lab facilities.
They forsee a great demand for heart transplantation in Belagavi as all the districts of north Karnataka and south Maharashtra have a very high incidence of very severe coronary artery disease, valvular heart disease, hypertension and diabetes.
People in these areas should be aware that :
1.Heart transplantation is a good option for end stage heart failure
2.It can be done at KLE Hospital
3.The recipient requires a heart from a brain dead beating heart donor
4.The donor heart usually comes from the intensive care units
5.All of us can register to be living organ donors