Heart transplant: how much it costs, where do it, the complexity of the operation and the effectiveness

The article 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 the issues of transplant rejection and survival (transplanted biomaterial).

The first studies that were carried out in the field of transplantation were started in the 50s of the last century. Successful interventions were performed by doctors in the United States 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 basis related to the host-transplant reaction has not been studied enough before, the duration and quality of life after surgical manipulation did not meet the desired results, and the prognosis was uncertain. Read about the cost of heart transplantation below.

Currently, the level of knowledge has increased significantly and allows for similar 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, suffered a sixth heart transplant at 99 years old.

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

Indications for transplantation

Cardiac transplant intervention is the least common cardiac surgery operation. This is due not only to high financial costs, but also with certain nuances:

1. A limited number of donors - individuals who have a healthy heart but have brain death.
2. The long time required to select a donor according to waiting lists. This problem is especially relevant in relation to heart transplant operations for a child.
3. A problem of an ethical nature, including from the point of view of religion (in particular, according to Christian ideas, a person is considered alive while his heart beats).
4. Short shelf life of the donor organ (up to 6 hours).

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

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

It is the symptoms characteristic of the last stage (the occurrence of dyspnea at rest, significant swelling of the whole body and limbs, a significant limitation of activity) in the absence of the effectiveness of conservative treatment may require a heart transplant. Cost for many does not matter.

So severe heart failure can occur as a result of the following pathologies:

1. Cardiomyopathy This disease is a condition in which structural reorganization of myocardial fibers occurs, replacement with scar tissue, as a result of which the process of contraction and relaxation of the heart muscle is disrupted. Typically, heart failure develops with ischemic and dilated cardiomyopathy.
2. Acquired or congenital inoperable heart muscle defects.
3. Tumors of the heart.
4. Severe cardiac arrhythmias and uncontrolled angina, which are not amenable to medical treatment and have led to severe cardiac functional impairment.

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

1. Lack of severe pulmonary hypertension.
2. The fraction of left ventricular stuffing is less than 20%.

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

1. The age of the recipient (the patient who is going to have an organ transplant) must be less than 65 years.
2. The patient's desire to follow a further strict plan of therapy and observation, his diligence.

Donor Heart Requirements

How much does a heart transplant cost is a relevant issue today. To understand this, you need to understand that an organ donor can be a person who is in a coma, and whose brain death has been confirmed, and cardiac activity is maintained in the intensive care unit using equipment. As a rule, such severe patients are observed in hospitals after strokes or accidents. That is, a person is actually already dead, since his heart works with drugs, and he breathes through a ventilator. If the heart of such a person is transplanted to another person, in a new organism it will be able to work autonomously. To remove an organ from the patient’s body, doctors need the consent of the patient, 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 in which the donor is located, fills out the necessary papers. After that, a specialist comes from the transplant center, always with an assisting 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 the cost of a heart transplant in Russia?

Donor hearts are selected according to the following criteria:

1. There are no malignant tumors.
2. There is no viral hepatitis (B, C), HIV infection.
3. The absence of cardiac pathologies, which is confirmed by the results (coronary angiography, ultrasound of the heart, ECG).
4. The blood groups of the recipient and the donor are compatible according to the ABO system.
5. The dimensions of the heart of the recipient and the donor of the heart are approximate. Evaluation is carried out using ultrasound.

Transplant waiting time

To understand how much a heart transplant costs in Moscow, we first determine what the terms are. In order for the patient to have surgery, a waiting list is drawn up at the transplant center. These centers collaborate with medical institutions where potential donors can be observed - neurological, traumatological and other hospitals. The center periodically asks the hospitals for information on the availability of possible heart donors, and then compares the list of patients who need a transplant with available donors in accordance with the selection criteria listed above. The patient can get a referral to the transplant center from the attending physician - cardiac surgeon or cardiologist.

Since the preparation of the waiting list, a fairly large amount of time can pass. If a suitable donor is not found, then the patient may die due to insufficiency of cardiac activity, without waiting for transplantation. If a donor is found, then a transplant operation will be carried out in the near future.

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

How much does a heart transplant cost?

All over the world, a law has been passed that prohibits organ trafficking, exclusively kinship or cadaver transplantation is permitted. In this regard, the patient receives the heart itself free of charge. You will only need to pay for the operation itself, medical support before and after transplantation, 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 thousand rubles. In the Russian Federation, it is possible to provide citizens with high-tech types of medical care free of charge, as well as to pay for transplant operations according to quotas (according to the compulsory medical insurance system), however, in any case, the possibility of free transplantation and its exact cost should be clarified by the attending specialist.

Where do heart transplants do? On the territory of Russia there is only one coordination center that selects donor organs. It operates in the Moscow region and Moscow. Direct heart transplants are performed in the following medical institutions:

1. "North-West Federal Medical Research Center. Almazova V.A. ” FSBI, 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 (FSBI "FNTSTIO").

In recent years, they began to develop transplantology in Chelyabinsk, namely in the Chelyabinsk Regional Clinical Hospital. What is the cost of a heart transplant in Chelyabinsk? The price needs to be clarified in clinics. But it is not very different from the capital.

In addition, they carry out transplantation 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 the legislative and legal standards for organ donation are not fully developed in Russia, heart transplantation operations are very rare. For example, during 2014, only 200 such manipulations were performed, while in the United States about 28 thousand transplant operations were performed during the same period. In addition, due to the legislative prohibition on the removal of donor organs from people under 18 years of age, children who need a heart transplant need expensive treatment abroad (India, Germany and Italy). However, in May 2015, a legislative act was passed on the procedure for stating brain death in patients older than 1 year. This made it possible to further develop legislation in the field of child donation.

Question: “How much does a heart transplant cost in Germany?” occurs almost immediately after a decision on the operation. Prices in different clinics vary. On average, it is 400 thousand euros.

Contraindications to 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 a lesion of the retina, kidneys, blood vessels.
3. Active tuberculosis process, HIV infection.
4. Acute forms of infectious diseases.
5. Severe forms of hepatic and renal failure.
6. Systemic autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, and 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.

Surgical preparation process

If the patient is sent to the transplant center and a decision is made to put him in the queue for an organ transplant, he is assigned a special examination plan. The necessary analyzes in this case are:

1. Inspection of a urologist, gynecologist.
2. Inspection of the dentist, ENT specialist (this is necessary to exclude the presence of chronic infectious foci in the oral cavity and nasopharynx).
3. Cardiac surgeon examination.
4. ECG, ultrasound of the heart, CAG (if necessary).
5. General laboratory examination of urine samples.
6. Clinical laboratory study 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 hospitalization in the transplant center for surgery, in the event of a donor, the patient should always have copies and originals of the following documents:

1. Passport, health insurance policy, SNILS.
2. An extract received at the sending institution and containing the results of all the examinations carried out.
3. Referral received at the medical institution at the place of registration of the recipient. Information on the cost of a heart transplant operation should be collected.

Transplantation procedure

The heart transplant procedure in Moscow begins with the removal of the 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 (sedation and analgesic drugs are administered). Then, in the operating room using general anesthesia, the anterior chest wall is cut to the recipient, large vessels are connected to the apparatus performing cardiopulmonary bypass (AIC), which will perform the function of an artificial heart during the operation.

Then, the left and right ventricles of the heart are cut off. Atria are retained. Preserving your own atria allows you to leave the sinus node active, which sets the rhythm of heart contractions and is a pacemaker.

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

The next stage of surgical intervention is cardiotonic (supporting cardiac activity) and immunosuppressive treatment. Inhibition of immunity (usually through the use of cyclosporine) is required to eliminate rejection reactions and successful engraftment.

Possible complications after transplantation

Among the complications that can occur in the early period after surgery are bleeding from a wound, infectious lesions. The first is quite successfully treated by reopening 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 distant period after surgery, the development of transplantation of the heart, as well as dysfunction of the coronary arteries, accompanied by myocardial ischemia of the donor organ, is likely.

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 transplantation

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

1. Nutrition. It is important for the patient to switch to a healthy lifestyle, completely abandon the use of alcoholic beverages, tobacco 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 regime. However, the usual daily activity should still be present. After a couple of months, the patient is allowed to return to driving, after a few more - to begin light physical exertion (walking, gymnastics and more).
3. Infection protection. The patient should try to avoid visiting public places for several months after transplantation, contact with people with infectious diseases. It is equally important to wash your hands thoroughly before eating, drink exclusively boiled water, and consume foods that have undergone good heat treatment. , - , , .
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Earlier, when the field of transplantology was just beginning to develop, representatives of almost all religions had an ambiguous opinion regarding heart transplantation. For example, representatives of Christianity believed that such an operation is not a charitable matter, since a living heart is 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 have begun to say that saving someone else's life after their own death is the true destiny of a believer, since sacrifice is the basis of such an action. And giving your heart is a blessing to other people.

We examined the cost of heart transplantation in Russia.