Moving hearts on a knife's edge

Tue, Sep 18, 2012, 01:00

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.

“At the last minute, you hear everything is definitely going ahead, that the organ looks good and literally the [recipient] patient goes directly to theatre.”

Timing is critical. “The heart needs to be in and beating within four hours of it being retrieved from the body which may be 200 miles away,” he says. Ambulance and air crews often come into play.

“Everyone on the night is very aware it’s a very important night for the recipient. It’s their one chance and it needs to go well.”

It’s a very important night for the donor family too of course he says. “What donor families say later is that it helped them in some way in the midst of their tragedy to know the organ was going to literally save someone’s life. And that’s exactly what it does.”

Once they know the heart is close, the Mater team connects the recipient to a machine that takes over the work of the heart and lungs.

“Once we see the donor heart coming through the door, we take out the heart that isn’t working and straight away we start implanting the donor heart,” says McCarthy.

As the heart lung machine is gradually withdrawn, the new heart starts to beat itself. All going well, most patients are awake and talking to their families in two or three days and can be home in about two weeks.

“The whole staff of the hospital get a good lift within a few days of the transplant,” says McCarthy. “Genuinely people are very happy about that in the hospital, which is nice to see.

“Everyone is aware of the other side of it too, the tragic side,” he says.

“This is a huge gift the donor family has given. We are very thoughtful about that.”

While 15 years ago an average of 10-15 transplants a year were performed here, numbers have declined in line with global trends

‘I’m grateful to my donor’

IT WAS January 2011 when 25-year-old Sarah Jordan started to feel unwell. Fit and active all her life, her sudden breathlessness was a mystery.

“I had kind of flu-like symptoms, I was cold and tired. I had swelling in my ankles and legs and I was struggling to walk from the office to the car. At home it was getting harder to climb the stairs,” she recalls.

When three weeks of antibiotics failed to work, she sought the opinion of another GP. She was referred straight to AE at Cork University Hospital where tests revealed heart failure.

“I was shocked, I didn’t know what to expect,” says Jordan. Kept in the coronary care unit there for two months, further tests revealed a virus had caused her heart failure.

“The virus attacked the heart muscle and enlarged the right side. It’s known as viral dilated cardiomyopathy,” she explains. “I’d never come across anything like it before. When I was so healthy, I didn’t think it could happen to me. They didn’t know where the virus had come from.”

While Jordan was fitted with a cardiac device to maintain the rhythm of her heart and was discharged, life had become very different.

“Everything had changed for me, my work life, my social life,” she says. “I’d usually come home from work and take the dogs for a walk, now I was sleeping downstairs because I couldn’t climb the stairs. I had to get mum to help me to wash my hair.”

Referred earlier this year to the Mater by her consultant Dr Peter Kearney for assessment for eligibility for transplant, around the same time her condition started to deteriorate. With her heart now working at only 16 per cent of its capacity, Jordan was put on the transplant list.

“I was terrified to be honest. I’d never thought about heart transplants before but I knew it was going to be a good thing and I could get my life back.”

While her family visited regularly from Cork, she describes the 10-week wait in hospital in which she had three offers of a heart as a time of emotional highs and lows.

Each time a heart became available, initial preparation for surgery would commence. On two occasions the heart was found to be the wrong match for Jordan. The third time, she was lucky.

She recalls waking up two days after surgery to feel relief. “I knew there was a long road ahead of me but I was delighted with the opportunity.”

Home in just over two weeks, she slept upstairs again for the first time in a long time.

“Now I’m able to go out and walk for up to an hour, I’ve been venturing out with my friends again and I have a lot more energy,” she says.

“I’m grateful to my donor and my donor’s family for the gift of life they’ve given me. Every morning I wake up, I think of them, I light a candle for my donor every week. Who knows what would have happened if a suitable donor didn’t come up?”

That Jordan’s own father died of cardiac arrest in 2011, while she was awaiting transplant, makes her all the more aware of heart health.

“It’s been a hard year and a half for everyone but it has all worked out in the end. Someone has been looking down on me.”

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