Your heart beats more than 100,000 times a day. In just a minute, it pumps over five liters of blood throughout your body. But unlike skin and bones, the heart has a limited ability to repair itself. So if this organ is severely damaged, there’s often only one medical solution: replacing it. Today, nearly 3,500 heart transplants are performed each year in a complex and intricate procedure with no room for error.
Vaše srce kuca više od 100 000 puta dnevno. U toku jednog minuta, ono ispumpa preko pet litara krvi kroz vše telo. Ali za razliku od kože i kostiju, srce ima oraničenu mogućnost reparacije. Zbog toga, ako je ovaj organ ozbiljno oštećen često postoji samo jedno medicinsko rešenje: zameniti ga. Danas, skoro 3 500 transplantacija srca se izvodi svake godine pomoću kompleksne i zamršene operacije bez mesta za grešku.
The process begins by testing potential recipients to ensure they’re healthy enough for this demanding operation. Doctors are especially concerned with identifying immunocompromising illnesses or any other conditions that could compromise a patient's chance of survival.
Proces započinje testiranjem potencijalnih primaoca da bi se utvrdilo da li su dovoljno zdravi za ovu zahtevnu operaciju. Doktori posebno obraćaju pažnju na imunodeficijentne bolesti ili bilo koja druga stanja koja bi mogla da ugroze preživljavanje pacijenta.
The next step is to match an eligible recipient with a heart donor. Donors are often comatose patients with no chance of being resuscitated or victims of a fatal event whose hearts are still healthy. In both cases, these patients need to be registered as an organ donor or have their families give consent. And even when a heart is available, surgeons can’t just pair any donor with any recipient. The recipient’s immune system will view a transplanted heart as a foreign organism that must be attacked. So doctors need to match recipients with donors that share their blood type and have similar antigens.
Sledeći korak je povezati kvalifikovanog primaoca sa davaocem organa. Davaoci su često pacijenti u komi koji nemaju šansu za buđenje ili žrtve smrtonosnih događaja čija su srca i dalje zdrava. U oba slučaja, ovi pacijenti moraju biti registrovani kao davaoci organa ili njihove porodice moraju pristati na proceduru. A čak i kada je srce dostupno, hirurzi ne mogu spojiti bilo kog davaoca sa bilo kojim primaocem. Imuni sistem primaoca će posmatrati srčani transplant kao strani organizam koji mora napasti. Zbog toga doktori moraju da povežu primaoce sa davaocima iste krvne grupe kao i one sa sličnim antigenima.
If a match can be made, the surgery can begin. Once the donor's heart is confirmed to be healthy, the organ is immersed in an ice slush and injected with a solution to induce cardiac arrest. These treatments stop the heart from pumping to ensure it can be removed cleanly. Surgeons then place the organ in a mix of cold saline and preservation solution.
Ako su oba učesnika kompatabilni, operacija može da počne. Kada se utvrdi da je donorovo srce zdravo, ono se stavlja u ledenu ,,bljuzgavicu” i daje mu se rastvor koji izaziva srčani zastoj. Ovo se radi da bi srce prestalo da kuca i da bi moglo sigurno da se ukloni. Hirurzi zatim stavljaju organ u mešavinu hladnog fiziološkog rastvora i rastvora za prezervaciju.
This is when the clock starts. Disconnected from its blood supply, the heart’s cells start taking on damage from lack of oxygen. The organ will only remain viable outside the body for a few hours, so it needs to reach its recipient as fast as possible.
Ovog trenutka sat počinje da otkucava. U stanju bez krvi, srčane ćelije bivaju oštećene zbog manjka kiseonika. Organ u ovom stanju će ostati održiv izvan tela svega nekoliko sati, zbog čega mora stići do primaoca što je pre moguće.
Once the heart arrives, the recipient is put under general anesthesia. The surgeon makes an incision down the length of the chest, cutting through the breastbone to separate the rib cage and expose the heart. To keep blood flowing while they remove the damaged organ, surgeons use a cardiopulmonary bypass machine. This takes over the heart's job, generating enough force to push blood through the patient's circulatory system.
Kada srce stigne, primalac se stavlja pod opštu anesteziju. Hirurg pravi rez duž grudi, seče grudnu kost da bi razdvojio grudni koš i otkrio srce. Da bi krv cirkulisala dok se oštećeni organ uklanja, hirurzi koriste mašinu za kardiopulmonalni bajpas. Ona preuzima posao srca i stvara dovoljno jaku silu koja gura krv kroz krvne sudove pacijenta.
After the old heart is removed, the surgeon begins sewing the donor heart into place. This is an incredibly precise process, where each blood vessel and artery must be carefully attached to avoid leaks. The procedure can last several hours, potentially longer if there’s scar tissue from previous surgeries. Once it’s finished, the bypass machine is turned off and blood is allowed to flow into the aorta. Doctors carefully monitor the new heart to ensure it’s beating on its own before sewing the recipient back up.
Nakon što se staro srce ukloni, hirurg počinje da ušiva srce davaoca na mesto. Ovo je veoma precizan proces gde se svaki krvni sud i arterija moraju pažljivo povezati da bi se izbeglo curenje. Operacija može da traje nekoliko sati, ponekad i duže ako postoji ožiljno tkivo zaostalo od prethodnih operacija. Kada je sve gotovo, mašina za bajpas se gasi i krv ulazi u aortu. Doktori pažljivo posmatraju novo srce da bi se uverili da samostalno kuca pre nego što zašiju pacijenta.
Even after the procedure is complete, there's still work to be done. Surgeons are unable to directly connect the heart to the recipient’s nervous system, and it can take years for the body to fully innervate the new organ. During this period, the transplanted organ has a higher resting heart rate and risk of stroke, making exercise difficult and dangerous. And since it’s incredibly rare to find a perfect match between donor and recipient, the immune system will also have some response to the new heart. Immunosuppressive drugs can help manage the risk of rejection, but they also leave patients open to contracting dangerous infections. It requires constant monitoring and testing to balance these two concerns.
Čak i nakon operacije, posao nije gotov. Hirurzi nisu u stanju da direktno povežu srce sa nervnim sistemom primaoca, a potpuna inervacija novog organa može potrajati godinama. Tokom ovog perioda, transplantirani organ ima višu frekvencu u mirovanju i veći rizik od srčanog udara, što otežava i ugrožava pacijenta za vreme vežbanja. Takođe, pošto je potpuno podudaranje između donora i primaoca neverovatno retko, imuni sistem će takođe reagovati na novo srce. Imunosupresivni lekovi mogu da smanje rizik od odbacivanja, ali takođe čine pacijente podložnijim opasnim infekcijama. Zbog toga, ova dva problema zahtevaju konstantno nadgledanje i testiranje.
Despite these challenges, about 70% of heart transplant recipients survive for at least five years after the operation, and just over 20% live another 20 years. So when this procedure is successful, it's truly lifesaving. Unfortunately, people in developing countries are often unable to access this surgery, and many viable hearts can’t be donated due to legal and regulatory issues. Thousands of people remain on waiting lists, and many are never able to find a suitable donor.
Uprkos ovim izazovima, oko 70% primalaca stransplanta živi minimum pet godina nakon operacije, a oko 20% živi dodatnih 20 godina. Dakle, kada je ova operacija uspešna, ona zaista spasava život. Na žalost, ljudi iz zemalja u razvoju često nisu u mogućnosti da dobiju pristup ovoj operaciji, a mnogi pogodni organi se ne mogu donirati zbog pravnih problema i regulacija. Hiljade ljudi ostaje na listama čekanja, a mnogi od njih nikad neće uspeti da nađu odgovarajućeg donora.