A heart transplant is surgery to replace a diseased heart with a healthy one from an organ donor. Organ donors are adults or children who have become critically ill, often because of injury. They will not live because of their illness or injury. If the donor is an adult, he or she may have agreed to be an organ donor before becoming ill. Parents or spouses can also agree to donate a relative’s organs. Donors can come from any part of the U.S.
Heart transplants are recommended for children with severe heart problems who cannot live without having their heart replaced. Illnesses that affect the heart include congenital heart disease, present at birth, and heart muscle disease (cardiomyopathy).
There are risks with any surgery, especially major surgery like this. Risks include:
- Failure of the transplant
- Infection, especially from antirejection medicines
- Heart failure
- Blood clots
- Lung problems
Once at the hospital, your child will have tests to confirm the match of the organ. Once the test results are available and your child is ready, he or she will go to the operating room. The transplant surgery may take four or more hours, and the time it takes depends on many things. During the surgery, a transplant team member will tell you about the progress of the transplant. The general steps of heart transplant surgery are:
- Before the surgery, your child will get sleep medicine (general anesthesia).
- The surgeon uses the open-heart method. This means he or she makes a large cut (incision) into your child’s chest, and the breastbone is spread to reach the heart.
- Your child is hooked up to a heart-lung bypass machine. The machine acts as your child’s heart and lungs and pumps blood through your child’s body during surgery.
- The surgeon will remove your child’s heart, and he or she will then put the new heart in your child’s chest and stitch it into place.
After the surgery, your child will go to the intensive care unit (ICU) to be watched closely. The length of time your child will spend in the ICU will vary. After your child is stable, he or she will be sent to the cardiac unit. Your child will continue to be watched closely. Your transplant team will help you learn how to care for your child during this time. This will include information about medicines, activity, follow-up, diet, and any other specific instructions from your child’s transplant team.
Rejection is a normal reaction of the body to a foreign object. The body’s immune system makes antibodies to try to destroy the new organ. Medicines (antirejection) are used to help prevent this from happening.
These are the most common signs and symptoms of rejection:
- Decreased urine or fewer wet diapers than usual
- Fast heart rate
- Fast breathing rate
- Weight gain
- Poor appetite
Your child’s transplant team will tell you who to call immediately if these symptoms happen.
Your child will need to take antirejection medicines for the rest of his or her life.
Because antirejection medicines weaken the immune system, children who get transplants will be at higher risk for infections. Your child will have blood tests to measure the level of antirejection medicine. For example, blood tests will be done to check white blood cell counts.
The risk for infection is higher during the first few months after surgery, and this is because higher doses of antirejection medicines are given during this time. Your child will most likely take medicines to prevent other infections from happening. Your child is at increased risk for infections such as oral yeast infections (thrush), herpes, and respiratory viruses.