Moving hearts on a knife's edge

A heart transplant requires good timing and involves a great deal of emotion, writes JOANNE HUNT

‘THE FIRST time I saw it I was amazed, and we are still amazed every time we see it,” says Dr Jim McCarthy of the heart transplants he performs.

A cardiothoracic surgeon at the Mater hospital, the first and only hospital in the State to perform heart transplants, McCarthy is also vice-president of the Irish Heart Foundation.

With his hospital having carried out 10 heart transplants already this year, the people who come under McCarthy’s care are at the end stages of heart failure. “Their heart isn’t really an efficient pump anymore,” he explains. Feeling breathlessness and extreme fatigue, the reasons for their heart failure can vary.

“Often it’s a disease of the heart muscle called cardiomyopathy,” he says. Or it can be down to coronary artery disease due to family history, high cholesterol or blood pressure or diabetes. While in the earlier stages patients can be treated with medication, special pacemakers or artificial hearts, for others a heart transplant is their best or only course.

The first transplant in the world was performed in 1967 and the first in Ireland was in 1985. While 15 years ago an average of 10-15 transplants a year were performed here, numbers, in line with global trends, have declined.

“It’s probably due to less young donor availability which in a way is a good thing as there is better car safety,” says McCarthy, but better medical treatment has also played a role.

A person undergoing a heart transplant falls into two main categories, he says. The first is typically aged 45-70 and, having developed coronary artery disease or had heart attacks and subsequent treatments, scarring means the heart no longer works well.

Young people aged 15-30 form the second group. “They’ve been leading a normal life, they get a flu-like illness and feel breathlessness and fatigue and within three or four weeks they could be on a transplant list. That can be very frightening,” he says.

“If we feel a patient may have a limited life expectancy, and often it’s less than a year, we advise that transplantation is the best way to go.”

Transplant co-ordinators spend much time with such patients explaining every aspect of the procedure in advance.

With currently seven people awaiting a heart in Ireland, and blood type and heart size a factor, a match is not always easy to find.

“The patient gets a bleep . . . they can expect a call, and it’s often late in the evening, to say get to the Mater as soon as you can. They normally have a bag packed and they may get a Garda escort.”

The night of a transplant is a particularly tense time. On hearing there may be a heart available, one team from the Mater goes to the donor’s hospital while another waits with the recipient.