Medical Intervention

Genesis Figueroa
Victoria Fuenmayor
Victoria Guerrero
Amanda Medina
Daniela Padron
Dr. Diaz
Activity 4.3.6
Are all Transplants the Same?
Procedure #1
Work with a partner to brainstorm what steps would be necessary in order to transplant a
human heart. During your brainstorming session, make sure to discuss the following:

o How is the structure of the heart related to its function?

The structure of the heart is related to its function within the circulatory system. Comprising four
chambers (two atria and two ventricles) the heart’s design enables efficient pumping of blood
throughout the body. This includes the left side receiving oxygenated blood from the lungs and
delivering it to tissues via the systemic circulation, while the right side receives deoxygenated
blood from the body and pumps it to the lungs for oxygenation through the pulmonary
circulation. Valves within the heart ensure the unidirectional flow of blood, while its muscular
walls facilitate the rhythmic contractions necessary for circulation.
o How does the heart interact with the lungs?
In its interaction with the lungs, the heart plays a vital role in the exchange of oxygen and carbon
dioxide. Deoxygenated blood returns to the heart from the body and is pumped to the lungs for
oxygenation, while oxygenated blood is then returned to the heart to be circulated throughout the
body. This relationship between the heart and lungs ensures the delivery of oxygen to tissues for
cellular respiration and the removal of carbon dioxide from the bloodstream.
o How is the heart attached to the body?
The heart is attached to the body within the pericardium, a protective sac-like membrane.
Additionally, it is connected to major blood vessels such as the aorta, pulmonary arteries, and
vena cavae, facilitating the flow of blood to and from the heart. This attachment ensures stability
and proper positioning of the heart within the thoracic cavity, allowing for its efficient function.
o What special considerations are necessary for a heart transplant which are not
necessary for a kidney transplant?
Special considerations for heart transplants differ significantly from other organ transplants, such
as kidneys. The complexity of the heart’s structure and its critical role in circulation necessitate
careful surgical procedures and post-transplant management. Immune rejection is a major
concern, requiring lifelong immunosuppressive therapy to prevent the recipient's immune system
from attacking the transplanted heart. Donor matching is crucial to minimize the risk of rejection
and ensure compatibility between the donor and recipient, further complicating the transplant
process.
 o How is the heartbeat regulated?
The heart’s rhythm is controlled by its internal electrical system. Originating from the sinoatrial
(SA) node in the right atrium, electrical impulses coordinate the heart’s contractions, moving
through specific pathways to stimulate the atria and ventricles. Hormonal and neural signals also
influence heart rate and rhythm, enabling adjustments to metabolic demands and physiological
conditions. This intricate regulation ensures the heart adapts to various situations, maintaining
proper circulation.

Procedure #2, 3, 4, 5
Using prior knowledge and brainstormed ideas, design a procedure for a heart transplant
surgery. Use a diagramming tool to outline your procedure, include a clear description for
each step, and relevant pictures.

Procedure #6
Research heart transplants. Investigate which patients are eligible for a heart transplant,
interventions that are done before the actual transplant surgery, how long someone can live
without the transplant, the general steps involved in a heart transplant procedure, and life
after the surgery. Take notes in your laboratory notebook.

Eligibility for Heart Transplant

1. Severe Heart Failure: Patients with end-stage heart failure, refractory to medical
management, are considered for heart transplants.
2. Age: Typically, patients are between 18 and 70 years old, but this can vary depending on the
center's guidelines.
3. Overall Health: Patients should have no other significant medical conditions that would
affect their ability to tolerate the surgery and recovery process.
4. Psychosocial Evaluation: Candidates undergo assessments to ensure they have adequate
social support and psychological stability to cope with the transplant process.

Interventions Before Transplant Surgery

1. Medical Optimization: This includes managing heart failure symptoms with medications and
lifestyle modifications.
2. Evaluation: Extensive testing is done to assess the patient's overall health, including cardiac
tests, blood tests, and imaging studies.
3. Waitlisting: Patients are placed on a waiting list for a suitable donor heart based on factors
such as blood type, body size, and medical urgency.

Survival Without Transplant

The survival rate without a heart transplant varies widely depending on the severity of heart
failure and the effectiveness of medical management. On average, survival rates for patients with
end-stage heart failure are relatively low without a transplant, often ranging from months to a
few years.

Heart Transplant Procedure

1. Donor Heart Retrieval: A suitable donor heart is identified, and retrieval surgery is
performed.
2. Recipient Preparation: The recipient undergoes pre-operative preparations, including
anesthesia induction and surgical site preparation.
3. Implantation: The recipient’s diseased heart is removed, and the donor heart is implanted,
connecting it to the recipient’s blood vessels and ensuring proper blood flow.
4. Closure: Surgical incisions are closed, and the patient is transferred to the intensive care unit
(ICU) for post-operative monitoring.
Life After Heart Transplant
1. Immunosuppressive Therapy: Patients require lifelong medications to prevent rejection of
the transplanted heart.
2. Monitoring: Regular follow-up appointments are necessary to monitor for signs of rejection,
infection, and other complications.
3. Lifestyle Changes: Patients must adhere to a healthy lifestyle, including regular exercise, a
balanced diet, and avoiding smoking and excessive alcohol consumption.
4. Psychological Support: Many patients benefit from ongoing psychological support to cope
with the emotional and psychological challenges of life after transplant.

Procedure #7
Answer Conclusion questions 1 through 3.
1. Why is the heart/lung machine necessary when performing heart transplant
surgery?
The heart-lung machine, also known as cardiopulmonary bypass (CPB), is necessary during heart
transplant surgery primarily to take over the functions of the heart and lungs while the patient’s
heart is stopped for the transplant procedure. This machine oxygenates the blood, removes
carbon dioxide, and pumps blood throughout the body, allowing surgeons to work on the heart
without the need for it to beat or for the patient to breathe. This facilitates a bloodless and
motionless surgical field, making the delicate procedure of removing the old heart and
implanting the new one much safer and more manageable.

2. What is the purpose of leaving behind the back wall of the left atrium of the
patient’s heart?
Leaving behind the back wall of the left atrium during a heart transplant is typically done to
preserve the attachment of the pulmonary veins, which bring oxygenated blood from the lungs
back to the heart. By leaving this portion intact, surgeons can avoid complications related to
reconnecting these veins to the new heart, which can be technically challenging and time-
consuming. Preserving this part of the left atrium also helps maintain the structural integrity of
the heart and facilitates smoother post-operative recovery.

3. How does the defibrillator work to cause the heart to beat normally?
A defibrillator works by delivering an electrical shock to the heart, which temporarily stops all
electrical activity in the heart muscle. This brief interruption allows the heart’s natural
pacemaker, the sinoatrial node, to regain control and restore a normal heartbeat rhythm. In cases
of abnormal heart rhythms such as ventricular fibrillation or certain types of tachycardia, a
defibrillator can help “reset” the heart’s electrical system, allowing it to resume a normal,
coordinated rhythm.

Procedure #8
Take out your outline. Compare the procedure you designed to the actual procedure.
Reflect on how well your procedure matches the actual procedure. What steps did you
include in your procedure? What steps did you not include in your procedure?
Steps Included in My Procedure:
1. Preparation of Recipient: This step involves positioning the patient, administering
anesthesia, and ensuring readiness for surgery, all of which are essential preoperative measures.
2. Donor Heart Retrieval: The procurement and assessment of a suitable donor heart are critical
aspects of heart transplant surgery, and I included these steps accordingly.
3. Recipient Chest Incision: Making an incision in the chest to access the heart is a fundamental
part of the procedure, and I incorporated it as well.
4. Connection to Heart-Lung Bypass Machine: Utilizing a heart-lung bypass machine to
maintain circulation during the surgery is a standard practice in heart transplant procedures, and I
included this step appropriately.
5. Removal of Recipient Heart: Removing the recipient’s diseased heart is a pivotal step in
heart transplant surgery, and I covered it in my procedure outline.
6. Implantation of Donor Heart: Preparing and implanting the donor heart into the recipient’s
chest cavity is a crucial aspect of the surgery, and I included it in my procedure description.
7. Reconnection of Blood Vessels: Attaching the donor heart's blood vessels to the recipient’s
vessels is a critical step in ensuring proper blood flow post-transplant, and I addressed it in my
procedure.
8. Closure of Chest Incision: Closing the chest incision and ensuring wound stability is an
essential part of the surgical process, and I included it in my outline.
9. Postoperative Care: Transitioning the patient to the ICU, administering medications, and
coordinating rehabilitation are vital components of postoperative care, all of which I
incorporated into my procedure.

Steps Not Included in My Procedure:

While the procedure I outlined covers the core aspects of a heart transplant surgery, there are a
few additional steps and nuances that I did not explicitly mention:
- Detailed descriptions of specific surgical techniques and instruments used during the procedure.
- The process of testing the donor heart's function before implantation.
- The management of potential complications during surgery, such as bleeding or arrhythmias.
- Additional postoperative care measures, such as monitoring for signs of rejection and adjusting
immunosuppressive medications.

Procedure #9
Answer Conclusion question 4.
4. How does your heart transplant procedure compare to the actual heart transplant
procedure?
The heart transplant procedure I outlined closely resembles the actual procedure, encompassing
key steps such as patient preparation, donor heart retrieval, recipient chest incision, connection to
a heart-lung bypass machine, removal of the recipient’s heart, implantation of the donor heart,
reconnection of blood vessels, closure of the chest incision, and postoperative care. While my
outline captures the fundamental principles and sequence of events involved, it's important to
note that the actual procedure may involve additional details and variations based on individual
patient factors and advancements in medical technology.

Procedure #15
Answer the remaining Conclusion questions.
5. Why do you think there are fewer heart transplants performed each year than
kidney transplants?
There are several reasons for this discrepancy. Firstly, the demand for heart transplants often
exceeds the supply of suitable donor hearts, leading to longer waiting times and fewer transplant
surgeries performed overall. Additionally, heart transplant surgery is generally considered more
complex and carries higher risks compared to kidney transplants. The heart is a vital organ with
intricate connections and functions, and surgery requires precise techniques and specialized post-
operative care. Moreover, advancements in medical therapies for heart conditions, such as
medications and devices like pacemakers and ventricular assist devices, have expanded treatment
options and reduced the need for heart transplants in some cases.
6. How do you think heart and kidney transplants compare to other transplants, such
as of the lungs?
Heart and kidney transplants share similarities in terms of surgical techniques, post-operative
care, and long-term management with immunosuppressive medications. However, lung
transplants present unique challenges due to the complexities of the respiratory system and the
risk of complications such as rejection and infection. Lung transplant recipients often require
intensive rehabilitation and have a higher risk of respiratory issues post-transplant compared to
heart or kidney recipients. Additionally, the limited availability of suitable donor lungs further
restricts the number of lung transplant surgeries performed each year.
7. Given what you know about the cause of Diana’s kidney failure, why do you think
many kidney transplant patients receive kidney and pancreas transplants at the
same time?
Many kidney transplant patients with end-stage renal disease (ESRD) resulting from conditions
like type 1 diabetes may also have compromised pancreatic function. Type 1 diabetes can led to
both kidney and pancreatic damage over time. In such cases, simultaneous kidney and pancreas
transplantation (SKPT) offers several benefits, including improved long-term outcomes, better
glycemic control, and a reduced risk of complications related to diabetes. By replacing both the
kidney and pancreas in a single surgery, SKPT addresses both the renal and metabolic aspects of
the disease, providing patients with a better quality of life and potentially extending their
survival. Therefore, it's common for individuals with diabetic nephropathy, like Diana, to
undergo SKPT to address both their kidney failure and diabetes simultaneously.