Heart Failure: It is a condition that arises due to the inability of the heart to pump enough blood to meet the body’s needs. It doesn’t mean that the heart has stopped working; it simply means that the heart might be weak and is not working effectively.

Heart Transplant: It is a surgical procedure that aims at helping patients suffering from end-stage heart disease or heart failure. It involves the removal of the damaged heart from the patient's body and replacing it with a healthy heart from a deceased donor. It is a highly skilled procedure done at selected centres and requires an immense degree of specialisation. In order to conduct the transplant, doctors have to first make sure that the patient is healthy enough to cope up with the post-operative trauma. This is done by performing certain tests and screenings. The procedure can be performed on both adults and paediatric patients.

A heart transplant is a procedure that is performed when other treatments have failed to work. Heart failure can be a result of various conditions such as:

• Weakening of the heart muscle (cardiomyopathy)
  • Ischemic cardiomyopathy 
  • Dilated cardiomyopathy 
• Heart valve disease
• Coronary artery disease and defects
• Congenital heart defects
• Ventricular arrhythmias (Dangerous recurring abnormal heart rhythms, which are not easy to control with other treatments)
•  Amyloidosis (Infiltrative heart diseases)
• Congenital Heart Defects
• Failure of a previous heart transplant
• Dangerous Reoccurring life-threatening Arrhythmias 
• Refractory angina
• Fluid retention 
• Severe cardiac dysfunction

A heart transplant is preferred only in case of end-stage heart disease or failure which cannot be treated by any other means. Transplantation is right for you if your condition is true for the below mention statements:

• Have you tried all the other therapies and medications?
• Is the transplantation the last resort of treatment and you’ll likely to die without a heart transplant?
• Are you in good health other than the heart or lung diseases?
• Are you ready to adopt the changes that will come after transplant including complex drug treatments and frequent exams?

If your answer for any of the above question is “no” then heart transplant is not for you. Also, a candidate is not eligible for a heart transplant if he/she is suffering from any other problem such as 

• Severe diseases 
• Active infections
• Severe obesity
• Recent personal history of cancer

The doctors may conduct several tests like:

• Blood Tests
• Chest X-Ray
• Electrocardiogram (ECG)
• Metabolic Stress Test
• Echocardiogram
• Cardiac Computerized Tomography (CT) Scans
• Cardiac Magnetic Resonance Imaging (MRI)
• Coronary Angiogram
• Myocardial Biopsy
• Cardiac Catheterisation

A heart failure cardiologist or a surgeon will ask the patient to undergo these tests. 

Heart Transplant Preoperative Details

Before proceeding with the surgery the doctors have to make sure that the patient is fit for the procedure. This is done by performing a series of tests and screenings, including right heart catheterization. The patient might be prescribed certain medications, a week, or two before the surgery, to avoid any sort of perioperative or postoperative infections.

The whole surgery will be performed under the influence of general anaesthesia. 

Heart Transplant Operative Details

The heart transplantation is the procedure that actually consists of three operations.

• First Operation: Harvesting the heart from the donor - For a heart transplant procedure, the patient requires a donor’s heart that is used to replace the patient’s defective heart. A donor is usually an unfortunate person who has suffered irreversible brain injury/ brain death. The team of doctors keeps the donor’s heart working with the help of medications and other "life support" that may include a respirator or other devices. The team removes the heart along with other donated organs and keeps them preserved using ice and special solutions until they can be implanted. For heart, the transplant must take place within six hours of its removal.
• Second Operation: Removing the recipient's damaged heart - Depending on the medical condition of the patient, the process of the removal of the damaged heart can be very easy or very complicated (especially when a patient has had previous heart surgery). The doctor makes an incision in the middle of the chest and removes the patient heart. During the surgery, the patient is kept on a heart-lung bypass machine, which aids in keeping the oxygen-rich blood circulating in the patient’s body.
• Third operation: The implantation of the donor’s heart - The operation involves the final step of replacing the patient’s heart with the donor’s heart. The doctor, after transplantation, connects the donor’s heart to the main arteries and veins of the patient. This operation involves the creation of only five lines of stitches, or "anastomoses.” 

• The patient may be required to take complete bed rest for at least two weeks post-surgery. 
• Smoking and consumption of alcohol should be strictly prohibited. 
• The rehabilitation program should be started a day or two after the surgery without any delay. 
• The surgical site should be kept clean and covered at all times.
• Consult a specialised dietician for a proper diet plan. 
• In case of any pain or discomfort, immediately inform your doctor. 
• Be punctual with the medicines 
• Maintain a healthy lifestyle
• Blood pressure management is a must
• Don’t take stress or live/work in a stressful environment 
• Maintain a healthy BMI

Just like other surgical procedures, heart transplant too is accompanied by certain complications, the most common of which are: 

• Organ rejection
  • Signs of organ rejection include:
    • Fever (100.4°f)
    • Shortness of breath
    • Elevation in blood pressure
    • Chest pain 
    • Fatigue or feeling "lousy"
    • Symptoms of Flu such as headaches, chills, dizziness, aches, nausea, and/or vomiting

This is the reason why patients undergoing heart transplant are required to take anti-rejection medicines throughout their life. 

The other factors involved are:

• Kidney damage
• Lung Injury
• Infection at the site of the incision
• Bleeding (during or after the surgery)
• Breathing problems
• Blood clots 
• High blood pressure
• Osteoporosis (a severe thinning of the bones that can lead to fractures)
• Lymphoma (a type of cancer which affects cells of the immune system)
• Coronary artery disease   or Atherosclerosis of the heart's arteries
• Angina (chest pain)

A patient must seek immediate medical assistance if the complications do not improve.