Donor heart transplantation

In only 50 years, the practice of donor heart transplantation has come a long way from being a “surgical miracle” and singular risky operations to the everyday global surgical practice. More and more clinics introduce the practice of the transplantation of a donor heart to their patients, new laws are constantly adopted, and public institutions of organ donations are formed. But, with the development of science and technologies of transplantation, a lot of problems have appeared, the principal one being the shortage of donor organs.

This is especially true for donor heart transplantation. A lot of organs for the transplantation can be taken from the living donor – a kidney, parts of the liver, blood, and more. But the heart can only be taken from a donor with confirmed brain death. The heart is also hard to accept for the patient’s body, and the risk of rejection is high.

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The ethical part of the problem raises the most questions. Considering that even in countries, in which the number of heart transplantations in year is 5-10 times higher than in Russia, only 1 of the 10 patients lives until the moment of transplantation, the shortage of donor hearts has been the main problem for many years. In Russia, the buying and selling of donor organs is forbidden by the state law, which decreases the number of organs available for the transplantation, but removes almost all possibilities for illegal organ acquisition. In other countries, the presumption of consent is accepted – either the “soft” version, when organs can only be taken from the donor that gave the consent to do so, or the ‘hard’ version, when it is only forbidden to take organs from the patients who explicitly disagreed with being a donor. But, probably, the most common method is the acquisition of the organs for the transplant after receiving the consent from the deceased person’s relatives (this method takes place in Russia, too).

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Nowadays, rejection of the donor heart happens less and less frequently. The patient is prescribed with immunosuppressive drugs until the risk of the rejection becomes minimal, and the selection criteria become more and more strict. Yet the cases of a late rejection still happen: in one of the cases, the patient’s body rejected the donor heart 9 years after the surgery.

Donor heart transplant is a hope for the normal life to the patients with a case of heart failure in the terminal stage. But it is not the only option for the patients with such a problem. Recently, an alternative to the heart transplant has appeared in many countries, including Russia. It is a ventricular assist device, which provides an emergency recovery to the pump function of the patient’s heart. In some cases, the installation of such a device is only a temporary substitution of the heart’s functions for the patients waiting for the donor heart transplantation. In other cases, the ventricular assist device is a full substitute for the donor heart, which functions just as well and gives the patient a long and full life.