Memorial Şişli Hospital
Why receive heart transplant abroad?
The main issue patients face when trying to receive a heart transplant is legal regulations. In most countries, the paperwork and particular laws make the heart transplant (including for children) impossible or very hard to obtain. Patients often wonder how much does it cost for a heart transplant. They think that the price abroad is higher, but in some cases it is 2-3 times lower.
Heart transplant: indications and contraindications
The most common indication for heart transplant is a heart malfunction, which reduces patient life expectancy to 1 year.
Main indications for heart transplant:
- cardiomyopathy (dilatational, ishemical);
- congenital heart defects, reluctant to other treatment methods;
- chronic heart failure;
- arrhythmia;
- ejection fraction indicators are less than 20%.
Ejection fraction indicator represents quantity of blood ejected by heart ventricle during a contraction. Its normal value is 50-75%.
Contraindications for heart transplant:
- infections or chronic diseases exacerbation;
- obesity;
- vascular diseases;
- type 1 diabetes;
- history of brain blood circulation malfunction;
- history or present oncological diseases;
- mental disorders, drug addictions;
- HIV;
- age above 65.
Donor requirements
Heart is transplanted from a cadaver (brain-dead) donor if his or her relatives gave permission to use organs for transplantation. Case of death must be established and cerebral functions must be irrecoverable.
Requirements for heart donor are:
- no chest injuries;
- no history of oncological diseases;
- absence of cardiovascular diseases;
- absence of chronic infections including HIV, hepatitis;
- blood type and heart size are compatible with recipient;
- younger than 60 years.
Heart transplant cost
Average cost of heart transplant is derived from many factors. Following conditions influence heart transplant surgery cost:
- Urgency. Depending on the time frame and life expectancy, additional procedures may be required to keep a patient alive until a donor is found. This may also require airline transfer of donor that otherwise would not reach a patient in time.
- Duration of stay in the country. Duration of stay is determined by donor search time and patient’s rehabilitation period.
- Patient condition. Additional medicines and procedures may be needed to stabilize a patient if their condition is severe.
- Qualification of a doctor performing the surgery.
Preparation for heart transplant
Before being put on waitlist, a patient has to undergo following examinations:
- HIV test;
- blood test on acute and chronic infections (herpes, cytomegalovirus, Epstein-Barr virus);
- fungal infection screening;
- tuberculosis test (skin test);
- oncology screening;
- coronary angiography;
- chest organs X-ray and lung function evaluation;
- cardiac catheterization for vascular status assessment;
- echocardiography to determine the ejection fraction.
Echocardiography is also performed on patients who are already in a waitlist. It allows to monitor changes in heart functioning so physicians can estimate the time left to find a donor.
Based on individual criteria, doctors prescribe myocardial biopsy. It is carried out if there is a risk of chronic diseases in a patient, such as multiple sclerosis, lupus erythematosus, vasculitis. These diseases are contraindications to transplant.
Types of heart transplant operations
Orthotopic heart transplant
Orthotopic heart transplant is the most common transplantation method. A surgeon removes malfunctioning heart and replaces it with donor one. Cardiopulmonary bypass system is used during the operation.
Heterotopic heart transplant
During the heterotopic heart transplant, donor organ is placed near recipient’s heart. Indications to this type of operation is significant difference in heart sizes of donor and recipient as well as severe pulmonary hypertension.
Mechanical heart transplant
Artificial heart transplantation is a temporary measure for a patient who is already on a waiting list. It is performed if the patient’s condition is worsening and they may not wait for the donor organ. This process is called “bridging to operation”. Artificial heart prolongs life for several months and gives additional time for search.
How to choose heart transplant clinic
When choosing a clinic for heart transplant one should take into account:
- quality of clinic equipment;
- transplant team experience;
- physicians’ qualification;
- previous patients reviews;
- average operation success rates.
Heart transplant waiting time
In most countries, even in top heart transplant hospitals, waiting time for heart transplant exceeds 1 year period, they can prescribe bridging operation to maintain patient's condition until a donor heart is received. This operation presumes implanting of an artificial heart that will keep a patient alive. In India waiting period is around 2-8 months, regardless of citizenship. Note that patient needs to stay in the country where they plan to receive heart transplant, as donor organs expire extremely fast and the operation needs to be conducted as soon as possible.
Heart transplant operation in details
In most heart transplant hospitals the operation lasts for 5 hours, a patient stays under general anesthesia the whole time. The procedure includes the following steps:
- A surgeon makes incisions and saws the rib cage to gain access to the heart.
- A patient is connected to heart-lung bypass device to keep them alive during the operation process. Special catheters are applied.
- Malfunctioning heart of the recipient is replaced with donor one. Transplantologist reconnects and stitches major vessels to the new heart.
- Heart-lung bypass machine starts pumping the heart with enough amount of blood until it starts beating. Sometimes minor electrical shock is required to start the heart.
- Bypass machine is turned off and catheters are removed from patient’s body.
- A surgeon closes the breastbone with special wires and stitches the incision.
Postoperative period
Rehabilitation
After the operation, a patient stays in the intensive care unit (ICU) for 2 weeks under constant monitoring. In pediatric heart transplant centers, this period may last up to 1 month. Any abnormalities and vitals dynamic are recorded to produce adequate medical response. Physicians prescribe required supporting medication quantity of immunosuppressants individually for each patient. The latter is needed to avoid heart rejection. A patient needs to take immunosuppressants during their whole life. Due to immunosuppressants constantly weakening patient’s immune system, physicians advice to stick to hygiene routines and avoid any contact with contagious animals or people.
Outlook
Life expectancy after heart transplant ranges from 10 to 30 years. For most patients, it takes 3 months to completely recover. During this period patients stay at heart transplant centers. A patient undergoes numeral examinations and tests. Heart transplant coordinator assesses their condition prescribing accurate dosage of immunosuppressants and supporting drugs. Physical activities can be engaged no sooner than 4 months post-operation. Physicians will compose an individual diet plan for a patient. Alcohol and cigarettes are forbidden for consummation.
Risks
The operation bears risks of increased cardiovascular infections and diseases. Regular check-ups are required to detect and treat this conditions in time. It also known that after the transplantation patients have higher chance of receiving skin cancer. To prevent that, patients should use sunblock and/or limit their exposure to ultraviolet radiation.
How to receive heart transplant abroad?
To receive treatment abroad submit a request on Bookimed site and our Medical Coordinator will contact you to provide consultation on the matter. You will receive assistance in choosing an appropriate clinic, as well as scheduling your hospital stay. Bookimed will also help you process all medical documentation and coordinate your trip abroad.
If a patient’s condition is critical, heart transplant programs include specialized airline transfer. A patient will be accompanied by a team of doctors.
The answer to the question how much does a heart transplant cost can only be given by a transplantologist after studying provided medical papers.
Heart transplant in India
Below are listed specialized heart transplant hospitals in India. Undergoing heart transplant surgery in India has many advantages: medical personnel performs 5 thousand operations every year, having built up major experience. Heart transplant cost in India is at least 2 times lower than in Israel or Germany. Heart transplant surgery cost in India is less influenced by prices on drugs because most used agents are produced within the country as analogs to medicine manufactured by the USA but at much lesser expenses.
In other countries, a patient without a citizenship cannot be put on a wait list for a donor organ in that state.