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.
你的心臟一天跳動超過十萬次 僅僅一分鐘內, 它抽送超過五公升的血液流過全身 但不像是皮膚與骨骼, 心臟的自我修復功能相當有限 所以若是損傷太嚴重 通常就只有一種醫治方法: 更換它 如今,一年內會執行 將近 3500 個心臟移植手術 這是道複雜且精密的程序, 絕不容許出錯
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.
過程開始首先會測試可能的接受者 確保他們足夠健康 得以接受嚴苛的手術 能辨認出免疫功能低下的疾病 對醫生而言十分重要 或是任何可能危及病患存活的病狀
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.
下一步便是將心臟捐贈者 配對到一個合格的接受者 捐贈者通常都是 沒有機會甦醒的昏迷病患 或是經歷了致命事故 但有健康心臟的受害者 在這兩種情形之下, 這些病患須被登記為器官捐贈者 或是取得其家人同意 即使有可用的心臟時 外科醫師也不能 隨意配對捐贈與接受者 接受者的免疫系統會將移植的心臟 視為外來有機體並對其發動攻擊 所以醫生必須將有相同血型 和抗原的接受者配對
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.
若配對成功, 手術便可開始進行 一旦確認了捐贈者心臟是健康的 器官會被埋進碎冰中 並注入一種能引起心臟停搏的藥劑 這些步驟能讓心臟停止跳動 以確保它能被乾淨地移除 外科醫生接著會把器官放入 冰生理食鹽水 與保存溶液的混合液中
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.
這時候時間就十分寶貴了 斷開心臟的血液供應後 心肌細胞會開始因缺氧而受損 這個器官僅在體外的幾小時中存活 所以必須越快送給接受者越好
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.
一旦心臟送達, 接受者將接受全身麻醉 外科醫生會沿胸腔做一個切口 切開胸骨並分離胸廓 然後暴露出心臟 為確保在移除受損器官時 能維持血流 外科醫生會使用心肺體外循環機 來接管心臟的工作 產生足夠的力將血液 推送過病人全身的循環系統
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.
當舊心臟被移除後 外科醫生開始縫上捐贈的心臟 這是極度精密的過程, 每條血管與動脈 都必須小心的接合, 以避免溢漏 手術過程會持續上數小時 如果之前的手術產生疤痕組織 可能會花更久時間 手術完成後, 體外循環機會關閉 而血液便可開始流入主動脈 醫生會小心地監控 確保新的心臟是靠自己跳動之後 才將接受者縫合
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.
即使在手術完成之後, 還是有些工作待進行 外科醫生無法直接將心臟 連接到接受者的神經系統 故可能得花上數年 來使身體將器官完全接上神經 在這期間, 移植心臟會有較高的靜止心率 與中風的風險, 讓運動變得困難且危險 而又因為在捐贈者與接受者之間 找到完美匹配的器官非常罕見 免疫系統也會對新心臟做出反應 免疫抑制藥物可以降低排斥的風險 但也可能讓病患容易得到嚴重感染 這都需要持續的監測與檢查 來平衡兩者
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.
儘管面臨許多挑戰, 有七成的心臟移植接受者 在手術後至少五年內存活 而僅有超過兩成能再活 20 年 所以當手術成功時, 確實是能救人一命 不幸地是, 生活在發展中國家的人 通常無法進行這種手術 因為法律規範問題, 眾多有效的心臟無法捐贈 數千人仍在等待名單上 而許多人甚至無法找到 合適的捐贈者