Heart Transplantation

The concept of heart transplantation dates back to at least 400 AD in China. The book of Liezi tells a story of Bian Que exchanging the hearts of two warriors to balance their personal characteristics.

Milestones in Heart Transplantation

• 3rd December 1967: The first human-to-human heart transplant was performed by cardiac surgeon Christiaan Barnard at Groote Schuur Hospital in South Africa. Patient Louis Washkansky lived for 18 days before dying of pneumonia.
• January 1968: The first successful heart transplant in the United States was done at Stanford University by Dr. Norman Shumway.
• 27 April 1968: French surgeon Christian Cabrol performed the first European heart transplantation in Paris at La Pitie-Salpetriere Hospital. The patient was a 66 year old man, Clovis Roblain, who survived 53 hours before dying of a pulmonary embolism.

Scenario of Heart Transplantation in India: Need of the Hour

The Transplantation of Human Organs Act, 1994, governs organ transplantation in India. The reasons for the lukewarm scenario are:

• Lack of awareness among the lay public
• Apathy among medical professionals
• Ignorance of legal aspects

Orchestrating a team of surgical units, infectious disease specialist, immunologist, transplant coordinator, psychiatrist, dedicated cardiologist for management of congestive cardiac failure, intensivist, transplant nurses, anesthetist and histopathologist is a massive task, which the profit-driven private hospitals shy away from.

Quick coordination assumes significance as the period between retrieving the heart and transplanting it should not exceed four hours.

Cadaver Donor

• Identification of Donor
• Confirmation of Donor: Brain Stem Death
• Certification of Donor
• Screening of Donor
• Maintenance of Donor: Optimum haemodynamic, ventilatory and metabolic status
• Counseling of Relatives
• Finally, informing the Zonal Transplant Coordination Committee

Donor Harvesting of the Heart

• Awareness regarding brain death and its associated formalities among medicos
• Providing emergency care to accident victims in public hospitals
• Coordinated infrastructure to harvest the heart from distant centres