Heart Transplants As An Effective Solution To Heart Failure

Organ failure is a condition where an essential system in the body fails to perform its intended function. An example of a major organ that is susceptible to failure is the heart. The heart is an organ in the center of the body’s circulatory system. It “provides the pressure that forces the blood through arteries, capillaries and veins”. In cases of heart failure, the heart muscle cannot fulfill the body’s need for blood as it cannot pump effectively. There are many causes of heart failure, namely coronary artery disease (CAD), heart attack, cardiomyopathy. In the case of a coronary artery disease, the patient’s arteries are blocked by plaque. Heart attacks most commonly occur as a result of CAD, while cardiomyopathy is a disease that causes the heart muscle to become “enlarged, thick, or rigid”.

There are numerous symptoms and problems associated with heart failure. For instance, as a result of heart failure, the lungs will experience congestion due to the buildup of excess fluids in the area. This is caused by the blood flow backing up into the lungs, as the heart cannot receive blood and pump it normally. The patient may find it difficult to do physical activity as they will oftentimes be short of breath and have excessive coughing. Additionally, the kidneys will also be impacted. To adapt to the changes of blood flow, the body will only send oxygenated blood to the more important brain and the heart, and not the kidneys. This results in the kidney being unable to effectively filter the body’s excess water and cause the excess water to settle in the ankles, feet, and legs. This is also known as swelling, or edema. Overall, since the heart is a major organ in the body, there will be many consequences in the case of failure.

Scientific research has lead to many solutions for this issue, such as heart transplant. This is the necessary procedure for patients of end-stage heart failure – their condition is so severe they need a new heart. Heart transplants consist of three operations: harvesting the heart from the donor, removing the heart, and finally, inserting the heart in the patient. The diagram demonstrates the procedure, and which arteries and veins will be temporarily disconnected from the heart during the surgery until the donor heart is in place. During this stage, the patient will be put under general anaesthesia. It is an open heart surgery, where the patient’s diseased heart must be taken out and replaced with the healthy donor heart. The surgeon will sew the donor heart into the patient. After the surgery, the patient must take medicines named “immunosuppressants” for the rest of their life, as the body’s immune system will initially reject the heart, recognizing it as a foreign object. These medicines will ensure the body does not reject the heart and attack it, causing problems. For a heart transplant, the patient will need a donor heart.

The donor of a heart must be declared “brain-dead” prior to transplantation. The National Kidney Foundation defines brain death as “death based on the absence of all neurologic function”. Although a person who is brain-dead is considered dead, their other organs can still function with the help of ventilator, a machine that can “breathe” for the patient. Therefore, as the heart can still beat, it can be donated to someone who needs a new, healthy heart. According to Ahmet Kilic, et al. , in the article “Donor Selection in Heart Transplantation”, “the two central and unifying concepts in the selection of a donor heart for transplantation are (I) the quality of the donor heart and (II) the matching of the donor heart to the recipient’s individual needs”. Because of this, waiting times for a donor heart usually take a long time – “often more than six months”. Not only do the hearts need to be donated by someone that is brain-dead, the heart must suit the patient.

As with any other solution, there are advantages and disadvantages to having a heart transplant. Evidently, the prime advantage of having a heart transplant is that it is the only solution for someone who is suffering from end-stage heart failure. In cases where pre-surgery medicines and minor surgeries have failed, the patient may have to get a new heart. In short, it has the potential to save the life of a severely ill person. The survival rate for one year afterwards is approximately 85 to 90 percent, with an annual death rate of around 4 percent after. Nevertheless, there are consequences; the body’s immune system may reject the new heart and react negatively. As a result, the patient must take post surgery medicines all their lives to change the immune system’s response to the new heart. Heart transplant recipients “have an average of one to three episodes of rejection in the first year after transplantation”. There is also the threat of infection, as the post surgery medicines weaken the immune system so it does not attack the new heart. In the first year 22 percent of deaths occur because of infections while 18 percent of deaths are because of acute (sudden) rejection. Other risks include excessive bleeding during surgery, breathing problems, and even death.

Additionally, the waiting times for a suitable donor heart can extend to six months or more, and the waiting period may be costly due to medicine and hospital fees, if necessary. There are multiple implications of heart failure, particularly from the ethics aspect. As said by the University of Minnesota Center for Bioethics, “the primary ethical dilemmas surrounding organ transplantation arise from the shortage of available organs”. There are more recipients of hearts than the donors, which lead to complications such as waiting times and priority issues. As the chart shows, there are were 3244 heart transplants performed in the US in 2017. However, there were 3942 candidates waiting for a heart, meaning 698 people unable to get a transplant. This raises questions on the distribution of donor hearts and who decides who gets the transplant first.

For example, is it fair that a patient must wait longer simply because their case is not as severe? Another instance includes hereditary disease opposed to lifestyle choices. If someone requires a heart transplant because of poor lifestyle choices such as excessive smoking, is it fair that they get a transplant before someone who needs one because of hereditary heart disease? There are various criteria that can determine priority - namely, by waiting time, age, severity of condition, and rate of success. Although certain criteria may guarantee a higher chance of success, there is yet to be an established list that doctors and health officials can turn to when deciding which patient gets to receive the heart first. Since altruistic behavior cannot be expected, especially during cases such as end-stage heart failure, patients may complain about long waiting times or unfair distribution. The concept of waiting times may also result in immoral conduct like bribery or nepotism just to ensure a donor heart.

In conclusion, I believe heart transplants are an effective solution for heart failure and provide people opportunities to live a better life. However, due to the shortage of donor hearts, there are obviously issues with transplants, specifically ethics. Until there is a way to ensure every patient receives a heart, scientists should work towards other solutions such as artificial hearts. But until then, transplants continue to be a leading solution for heart failure.