Heart transplantation: how much it costs, where it is done, the complexity of the operation and the effectiveness

2024 Author: Curtis Blomfield | [email protected]. Last modified: 2023-12-16 20:44

In the article we will find out how much a heart transplant costs. Transplantology of this organ is a separate field of medicine. It arose at the intersection of immunology and cardiology. Immunology is a science that deals with human immunity and is of great importance in matters of rejection and engraftment of a transplant (transplanted biomaterial).

The first studies that were carried out in the field of transplantation were started in the 50s of the last century. Surgical interventions that ended successfully were carried out by doctors in the USA and South Africa in the 80s. In the USSR, the first such operation was carried out by V. I. Shumakov in 1988. Due to the fact that the immunological bases associated with the "host-graft" reaction were not previously studied enough, the duration and quality of life after surgical manipulation did not correspond to the desired results, and the prognosis was uncertain. Read about the cost of a heart transplant below.

Currently, the level of knowledge has increased significantly and allows you to perform such operations with a minimal likelihood of complications. In addition, life expectancy after a heart transplant is sufficient (slightly less than half of the patients after the intervention live more than 10 years).

In some cases, there is the possibility of repeated transplants, for example, one of the richest people in the world according to Forbes, D. Rockefeller, underwent his sixth heart transplant at 99.

Many patients suffering from various pathologies and their relatives are wondering how much a heart transplant costs.

Indications for transplantation

Heart transplant surgery is the least common operation in the field of cardiac surgery. This is due not only to high financial costs, but also to certain nuances:

1. Limited number of donors - individuals with a he althy heart but confirmed brain death.
2. Long time needed to match a donor according to the waiting lists. This problem is especially relevant in relation to heart transplant operations for a child.
3. An ethical problem, including from the point of view of religion (in particular, according to Christian ideas, a person is considered alive while his heart is beating).
4. Short shelf life of the donor organ (up to 6 hours).

But, despite the described problems, the transplant operation, although very rare, is carried out, and quite successfully. How much does a transplant operation costhearts, it is important to find out in advance.

The main indication for which the patient needs this operation is the final (terminal) stage of heart failure in a chronic form, or the third or fourth functional class, not amenable to drug therapy, with a survival forecast of less than a year in this condition.

It is the symptoms characteristic of the last stage (the occurrence of shortness of breath at rest, significant swelling of the whole body and limbs, significant limitation of activity), in the absence of the effectiveness of conservative treatment, that may require a heart transplant. Cost is irrelevant to many.

So severe heart failure can result from the following pathologies:

1. Cardiomyopathy. This disease is a condition in which there is a structural restructuring of myocardial fibers, replacement with scar tissue, as a result of which the process of contraction and relaxation of the heart muscle is disrupted. Usually, CHF develops with ischemic and dilated cardiomyopathy.
2. Acquired or congenital inoperable defects of the heart muscle.
3. Tumors of the heart.
4. Severe heart rhythm disturbances and uncontrollable angina pectoris that are not amenable to medical treatment and have led to severe impairment of cardiac functionality.

In addition to the indications listed above, the results of objective research methods (pulmonary artery catheterization, ultrasound of the heart) are taken into account:

1. Lack of severeforms of pulmonary hypertension.
2. Fraction of left ventricular ejection is less than 20%.

In addition, when planning surgery, certain conditions must be met:

1. Recipient must be less than 65 years of age.
2. The desire of the patient to follow a further strict plan of therapy and observation, his diligence.

Requirements for a donor heart

How much does a heart transplant cost - the question is relevant today. To understand this, you need to understand that an organ donor can be a person who is in a coma, and whose head brain death is confirmed, and cardiac activity is supported in the intensive care unit using equipment. As a rule, such severe patients are observed in hospitals after strokes or road accidents. That is, a person is actually already dead, since his heart works with the help of drugs, and he breathes due to the ventilator. If the heart of such a person is transplanted to another person, in the new organism it will be able to work autonomously. To remove an organ from a patient's body, doctors need the consent of the patient himself, drawn up during his lifetime, or his relatives. In the absence of relatives, or if the patient is not identified, his heart can be removed without official documentation.

A commission consisting of several people, including the head physician of the medical institution where the donor is located, fills out the necessarypaper. After that, a specialist from the transplant center arrives, always with an assistant nurse, and performs an operation, during which the donor heart is removed, and then placed in a container filled with cardioplegic solution, and transported to the center. What determines how much a heart transplant costs in Russia?

Donor hearts are selected according to the following criteria:

1. No malignant tumors.
2. No viral hepatitis (B, C), HIV infection.
3. Absence of cardiac pathologies, which is confirmed by the results (coronary angiography, ultrasound of the heart, ECG).
4. The blood types of the recipient and donor are ABO compatible.
5. Recipient and donor heart sizes are approximate. The assessment is carried out using ultrasound.

Transplant waiting time

To understand how much a heart transplant costs in Moscow, let's first determine the terms. In order for the patient to undergo surgery, a waiting list is drawn up at the transplant center. These centers cooperate with medical institutions where potential donors can be observed - neurological, trauma and other hospitals. Periodically, the center asks hospitals for information about the availability of possible heart donors, and then matches the list of patients in need of a transplant with available donors in accordance with the selection criteria listed above. A patient can get a referral to a transplant center from the attending physician - a cardiac surgeon or a cardiologist.

Sthe moment the waiting list is drawn up, a fairly large amount of time can pass. If a suitable donor is never found, then the patient may die due to cardiac failure, without waiting for transplantation. If a donor is found, then the transplant operation will be carried out in the near future.

Since the predicted survival of a patient with such an indication as CHF is less than a year, a donor should be found during this critical period.

How much does a heart transplant cost?

A law has been passed around the world that prohibits the sale of organs, only related or cadaveric transplantation is allowed. In this regard, the patient receives the heart itself for free. You will only need to pay for the operation itself, medical support before and after the transplant, as well as the rehabilitation period.

So, how much does a heart transplant cost in Russia? In general, the price varies and amounts to 70-500 thousand dollars. The average price of a transplant operation is 250,000 rubles. In the Russian Federation, it is possible to provide citizens with high-tech types of medical care free of charge, as well as pay for transplantation operations according to quotas (under the CHI system), however, in any case, the possibility of free transplantation and its exact cost should be clarified with the attending specialist.

Where is a heart transplant done? On the territory of Russia there is only one coordination center that selects donor organs. It operates on the territory of the Moscow region andMoscow. Heart transplants are carried out directly in the following medical institutions:

1. "North-Western Federal Medical Research Center. Almazova V. A.” FGBU, located in St. Petersburg.
2. Research Institute of Circulatory Pathology named after. Meshalkina E. N., located in Novosibirsk.
3. Federal Scientific Center for Transplantology and Artificial Organs named after. Shumakova V. I., located in Moscow (FGBU "FNTSTIO").

In recent years, the development of transplantology began in Chelyabinsk, namely in the Chelyabinsk Regional Clinical Hospital. What is the cost of a heart transplant in Chelyabinsk? The price must be specified in the clinics. But it is not much different from the capital.

In addition, transplantation is carried out in the capital of Belarus - Minsk. That is, the geography of such operations is rapidly expanding. How much does a heart transplant cost in Minsk? Its price is about 70 thousand dollars.

Due to the fact that in Russia the legislative and legal standards for organ donation are not fully worked out, heart transplant operations are performed very rarely. For example, during 2014, only 200 such manipulations were performed, while in the United States, approximately 28,000 transplant operations were performed during the same period. In addition, due to the legal ban on the removal of donor organs from people under 18 years of age, children who needed a heart transplant required expensive treatment abroad (India, Germany and Italy). However, in May 2015A legislative act was adopted on the procedure for ascertaining brain death in patients older than 1 year. This enabled the subsequent development of legislation in the field of child donation.

Question: "How much does a heart transplant cost in Germany?" occurs almost immediately after the decision to operate. Prices vary from clinic to clinic. On average, this is 400 thousand euros.

Contraindications for transplantation

Such surgery is contraindicated in the following situations:

1. Severe pulmonary hypertension (presence of high pressure in the pulmonary artery).
2. Severe form of diabetes, in which there is damage to the retina, kidneys, blood vessels.
3. Active tuberculosis process, HIV infection.
4. Acute forms of infectious diseases.
5. Severe forms of liver and kidney failure.
6. Systemic autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, others).
7. Severe chronic obstructive disease.
8. Drug, alcohol addiction.
9. Oncological diseases.
10. Acute stages of mental illness.

We talked about the cost of a heart transplant in Moscow.

The process of preparing for surgery

If a patient is referred to a transplant center and a decision is made to put him on the waiting list for an organ transplant, he is assigned a special examination plan. The analyzes required in this case are:

1. Examination by a urologist,gynecologist.
2. Examination by a dentist, otorhinolaryngologist (this is necessary to exclude the presence of chronic infectious foci in the oral cavity and nasopharynx).
3. Examination by a cardiac surgeon.
4. ECG, ultrasound of the heart, CAG (if necessary).
5. General laboratory examination of urine samples.
6. Clinical laboratory testing of blood samples, determination of blood group, coagulation system.
7. Blood tests for markers of syphilis, viral hepatitis, HIV infection.
8. X-ray examination of the organs of the chest cavity or fluorography.

For admission to a transplant center for surgery in the case of a donor, the patient must always have copies and originals of the following documentation:

1. Passport, he alth insurance policy, SNILS.
2. A statement received from the sending institution containing the results of all examinations carried out.
3. Referral received at a medical institution at the place of registration of the recipient. About the cost of heart transplant surgery, information should be collected.

Transplant procedure

A heart transplant procedure in Moscow begins with the removal of a donor organ from the body and placing it in a container with a cardioplegic solution for no more than 4-6 hours. During this time, preoperative preparation of the recipient is carried out (premedication - sedative and analgesic drugs are administered). Then in the operating roomusing general anesthesia, the recipient's anterior chest wall is cut, large vessels are attached to a heart-lung machine (ABC), which will perform the function of an artificial heart during the operation.

Then, the left and right ventricles of the heart are cut off. At the same time, the atria are preserved. Saving your own atria allows you to keep the sinus node active, which sets the rhythm of heart contractions and is the pacemaker.

After this, the donor's atria are sutured to the recipient's atria and a temporary pacemaker is placed to maintain adequate heart rate after transplantation. The chest is sutured, an aseptic bandage is applied. Such an operation takes several hours, usually no more than 6.

The next stage of surgery is cardiotonic (cardiac support) and immunosuppressive treatment. Immune suppression (usually through the use of cyclosporine) is required to eliminate rejection reactions and successful engraftment.

Possible complications after transplant

Among the complications that can occur in the early period after surgery are bleeding from the wound, infectious lesions. The first is quite successfully treated by re-opening the wound and suturing the source of bleeding. To prevent infectious (viral, fungal, bacterial) complications, the patient is prescribed antibiotic drugs and an adequate immunosuppression regimen.

In the remote period after the operationthe development of rejection of the transplanted heart is likely, as well as dysfunction of the coronary arteries, accompanied by myocardial ischemia of the donor organ.

Forecast

The cost of a heart transplant in Russia does not always affect the prognosis. It is most often favorable: more than 90% of recipients successfully survive the first year after surgery, about 60% - five years, about 45% - more than 10 years.

Lifestyle after transplant

The lifestyle of a patient in the postoperative period after a heart transplant procedure consists of the following components:

1. Food. It is important for the patient to switch to a he althy lifestyle, completely abandon the use of alcoholic beverages, smoking. It is necessary to follow a diet, excluding harmful foods (smoked, fried, fatty, and so on) from your own diet.
2. Physical activity. During the first month after surgery, the patient must strictly adhere to the restrictive regimen. However, the usual daily activities should still be present. After a couple of months, the patient is allowed to return to driving, after a few more - to start light physical activity (walking, gymnastics, etc.).
3. Infection protection. The patient should try to avoid visiting public places for several months after transplantation, contact with people suffering from infectious diseases. It is equally important to wash your hands thoroughly before eating, drink only boiled water, usefood products that have undergone good heat treatment. This is due to the fact that due to suppressed immunity, the patient is more likely to become infected with viral, fungal, bacterial diseases after the start of immunosuppressive treatment.
4. The use of drugs. This part of the life of a heart transplant patient is the most important. The patient will have to carefully observe the time of taking medications, exactly observe the dosage prescribed by the doctor. As a rule, we are talking about the use of hormonal drugs and cytostatics, the action of which is aimed at suppressing one's own immunity, which attacks foreign tissues of the heart muscle.

In general, it should be noted that the patient's life after surgery, of course, changes significantly, but the quality of life without edema, palpitations and shortness of breath changes for the better.

Religious heart transplant

Earlier, when the field of transplantology was just beginning to develop, representatives of almost all religions had an ambiguous opinion in relation to heart transplantation. For example, representatives of Christianity believed that such an operation was not a charitable deed, since a still living heart was actually taken from a person. In addition, it is believed that theoretically a person can come out of a coma after a few months. But due to the fact that doctors clearly differentiate the state of coma and brain death, more and more clergy in recent years began to say thatsaving someone else's life after one's own death is the true purpose of a believer, since such an action is based on sacrifice. And giving your heart is good for other people.

We reviewed the cost of a heart transplant in Russia.