Heart Transplantation
Heart failure, sometimes referred to as congestive heart failure, occurs when the heart muscle is unable to pump enough blood.
A number of factors can put a person at risk for heart failure, the most important of which include the following:
- High blood pressure
- Coronary artery disease
- Heart attack
- Diabetes
- Sleep apnea
- Congenital heart defects
- Heart valve disease
- Some viruses
- Alcohol consumption
- Smoking
- Heart rhythm disorders
- Obesity
The number of people with heart failure in the United States is more than 5 million, and 400,000 new cases are added to this number each year. The annual cost of treating heart failure in the US is estimated at about $10 billion, the bulk of which is related to hospitalization costs. The main strategy in reducing the costs of heart failure treatment is to reduce the patient's length of stay, one way of which is the definitive treatment of heart failure by performing a heart transplant. The main limiting factor in heart transplant operations is the small number of volunteers donating transplant hearts.
The world's first heart transplant was performed on December 3, 1967, at Groote Schuur Hospital in Cape Town, South Africa, by Dr. Christiaan Barnard. In this operation, the heart of a young 25-year-old woman who was killed in a car accident was transplanted to a 53-year-old patient with heart failure. The patient survived only 18 days after the transplant and died due to a lung infection. Barnard's second heart operation was performed in January 1968, this time the patient survived 19 months.
About 3,500 heart transplants are performed worldwide each year, the highest number of which is related to the United States with 2,000 to 2,300 operations per year. The cost of a heart transplant in different countries is shown in the table below. In our country, this operation is performed with the support of the Ministry of Health and the Board of Trustees, at a much lower cost within the country.
The five-year survival rate of patients with heart failure is less than fifty percent, while after a heart transplant, the patient's survival rate will reach fifty to sixty percent.
In 2014, a group of doctors at St Vincent's Hospital in Sydney, Australia, for the first time in the world, revived a dead heart and transplanted it to a 57-year-old woman who had congenital heart disease. In this novel method used in Sydney, a heart that had stopped beating was placed in a device called the "heart box". In this box, the heart is kept warm, the beat is revived, and a nutrient fluid helps to reduce damage to the heart muscles.
The first successful heart transplant in Iran was performed in 1993 by Dr. Mohammad Hossein Mandegar and colleagues in the heart surgery department of Dr. Ali Shariati Hospital in Tehran, and currently, in addition to the aforementioned center, heart transplant surgery is performed in Masih Daneshvari Hospital in Tehran, Shahid Rajaie Heart Hospital in Tehran, Hazrat Imam Khomeini Hospital Complex in Tehran, Shahid Dr. Mostafa Chamran Hospital in Isfahan, Hazrat Imam Reza Hospital (AS) in Mashhad, Namazi Hospital in Shiraz and Hazrat Baqiyatallah Hospital (AJ) is also performed. From 2008 to the end of 2023, with the support of HOA, more than 1450 heart transplant operations have been performed in transplant centers across the country, and in 2023, 115 heart transplant operations were supported in eight transplant centers.
The most common conditions requiring heart transplantation include:
- Severe heart damage after a heart attack
- Severe heart failure
- Severe congenital heart defects that cannot be corrected by surgery
- Life-threatening rhythm or rhythm disorders that cannot be corrected with other treatments
Conditions with relative contraindications for heart transplantation include:
- Patients with malnutrition
- Patients over 65 to 70 years of age
- Patients with a history of severe stroke or dementia
- Patients with a history of cancer in the past two years
- Patients with HIV infection
- Patients with active infectious diseases such as hepatitis
- Patients with insulin-dependent diabetes and visceral dysfunction such as impaired kidney function
- Patients with simultaneous kidney, lung and liver diseases
- Patients with pulmonary hypertension
- Addiction to smoking or other substances that lead to damage to the transplanted heart.
Considering that one of the operational programs of the Board of Trustees in order to achieve the lofty goals of establishing this board regarding creating a platform for the treatment of all patients within the country and eliminating the country's need to send patients abroad for treatment is to support the quantitative and qualitative growth and development of heart transplant operations in medical centers affiliated with the country's universities of medical sciences. The Board of Trustees has supported 1453 heart transplant operations in the past 16 years (2009-2023). (For each heart transplant operation, it undertakes part of the patient's treatment costs)
The support of the Board of Trustees for heart transplant patients is carried out in 3 areas:
- Providing part of the hoteling costs of heart transplant patients
- Providing the items needed to perform the transplant operation, such as tissue preservation solutions
- Assisting in equipping transplant departments