Heart transplantation is an established treatment for advanced heart disease. Since the advent of ciclosporin and other medications to control organ rejection, the survival rate of heart transplant patients has improved significantly. About 80 percent of heart transplant patients survive past the first year. A key factor to heart transplant is organ availability.
The National Heart Centre Singapore (NHCS) set up the heart transplant programme in 1990. To date, over 54 heart transplants have been carried out, giving recipients a new lease of life. The NHCS is the only healthcare institution in Singapore that carries out heart transplantations.
Patients suffering from end-stage heart failure where their condition cannot be relieved by conventional medical or surgical treatment may need a heart transplant.
A heart transplant is the replacement of a patient’s diseased heart with a healthy heart from a donor who has suffered brain death. The donor’s heart is completely removed and quickly transported to the operating theatre. During the operation, the patient is placed on a heart-lung machine which pumps blood throughout the rest of the body. The patient’s heart is removed, leaving the back walls of the heart’s upper chambers. The back chambers on the new heart are opened and the heart is sewn into place. The blood vessels are then connected and blood flow through the heart and lungs is resumed. As the heart warms up, it begins beating.
Patients are usually up and around a few days after the heart transplant. If there are no signs of the body rejecting the organ, patients are allowed to go home within two weeks.
Patients suffering from end-stage heart disease and under the age of 60 are the most likely candidates for heart transplant. The doctor, patient and family must address the following four basic questions to determine whether a transplant should be considered:
Patients who do not meet the above criteria or suffer from other conditions, such as other severe diseases, active infections or severe obesity, are not suitable candidates for a heart transplant.
Donors are individuals who are brain-dead, meaning that the brain shows no signs of life while the person’s body is being kept alive by artificial means. Most donors are those who have passed away due to road accidents, strokes or severe head injuries. Depending on the availability of a heart for transplant, patients may wait for months for a transplant.
The quality of life improves dramatically after a heart transplant. Patients are able to lead a more active lifestyle, which includes returning to work. To prevent the body from rejecting the transplanted heart, patients have to take several medications for life. A patient’s survival depends on many factors, including age, general health and response to the transplant. Survival rate worldwide is reported to be 86% at one year after surgery, 73% after five years and 60% after 10 years.
The Human Organ Transplant Act (HOTA) allows for the kidneys, liver, heart and corneas to be recovered in the event of death from any cause for the purpose of transplantation. Singapore Citizens and Permanent Residents above 21 years of age and of sound mind are included under HOTA unless they have opted out.
The Medical (Therapy, Education and Research) Act (MTERA) allows for any person above 18 years of age to pledge to donate their organs/tissues, or any body part or the whole body for the purpose of transplantation, education or research upon death. In the case where a person has not made a pledge under MTERA before passing away, the family members would be able to donate the organs and/or tissues or whole body of their loved ones under MTERA upon their death if they wish to do so. For more details on HOTA and MTERA, log on to www.liveon.sg or contact the National Organ Transplant Unit at +65 6321 4390.
For more information about this programme, please contact:
Clinical Coordinator Mechanical Circulatory Support, Heart and Lung Transplant National Heart Centre Singapore 5 Hospital Drive Singapore 169609 TeI: 6704 8130 Email: firstname.lastname@example.org
For more information about transplant services, please contact:
SingHealth Transplant Tel: 6326 5195 Fax: 6220 0730 Email: email@example.com Website: www.sgh.com.sg/transplant
Information correct as of August 2014.
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