A heart transplant for a child is the most difficult operation in this area, and it is performed much less frequently than for adults. A direct indication for such an surgical intervention will be if the heart disease goes into the terminal stage and the baby has about six months to live. Children’s donor hearts are rare and almost half of the children do not survive the operation.
The process of heart transplantation for a child is also somewhat more complicated than for an adult patient, and the percentage of survival is also much lower. Quite often, doctors are faced with late organ rejection, coronary arteriosclerosis, and nephrotoxicity.
In children, transplantation is somewhat more difficult than when an operation is performed on an adult. Therefore, they rarely resort to transplantation in babies, only if the patient suffers the terminal stage of heart disease with limited physical activity. In this case, upon refusal, the recipient is given no more than 6 months.
An absolute contraindication to surgery for children at an early age is the presence of systemic pathologies or an uncontrolled infection in an active form.
When a patient is put on the line, the prognosis of life is disappointing, he has to wait from 1 week to 1,5 years. 20-50% of these people die without waiting for a transplant.
Five-year survival in children is about 45-65%, within one year this figure is slightly higher and amounts to 78%. About 3% live for about 72 years, and only 25% live longer than 11 years after transplantation.
A very serious problem in the treatment of children is the high mortality rate. In addition, late rejection often occurs, nephrotoxicity occurs with prolonged use of cyclosporins, and coronary atherosclerosis develops faster.
The most dangerous reconstruction of the aortic arch, when deep hypothermia is performed, circulatory arrest.
Under what circumstances is surgery justified
Unfortunately, not every patient will be able to receive a donor heart. There are many different reasons for this:
- Very few donors. It can only be a person whose death is registered in the brain, and the heart is absolutely healthy.
- There is a very long queue to receive this body (waiting list), this is most relevant for children. The body should fully comply with all the stated requirements and, perhaps, several dozen patients who are much earlier in the list will have such parameters.
- Sometimes the donor organ cannot be delivered to the right place on time, since the operation must be performed no later than six hours after the removal.
- Many people do not agree to transplant on ethical or religious terms. For example, in Christianity, a person lives while his heart beats.
- The patient can be stopped by the fear of a long and rather expensive rehabilitation.
- Old age. Typically, surgery is not performed for people after 60 years, but there are exceptions.
In addition to the above obstacles, transplantation will not be carried out in case of a number of other diseases not related to cardiology. It can be:
- severe pulmonary hypertension;
- diabetes mellitus in the stage at which negative changes in the retina of the eyes have already begun in the vessels or kidneys;
- infectious diseases in the acute stage;
- HIV and tuberculosis;
- autoimmune diseases – rheumatism, arthritis, lupus erythematosus, etc .;
- severe hepatic or renal failure;
- chronic severe forms of lung disease;
- addiction to alcohol or drugs;
- severe mental disorders.
This period can be divided into 4 periods.
- Resuscitation period – lasts about ten days. Here the patient is given intensive therapy aimed at preventing rejection of a foreign organ, at stopping any other complications such as bleeding, allergic reactions, fluid accumulations in the pericardium, etc. At this time, the patient is very susceptible to any viral, fungal or bacterial infections. The task of medical personnel is to prevent such a development of events.
- Stay in the hospital – the patient will have to spend at least 30 days in the medical facility. During this period, an individual dosage regimen will be developed and a number of necessary studies will be carried out.
- Post-hospital period – the patient is at home, takes the prescribed medications, is observed by doctors and gradually switches to the usual way of life. This recovery time may take about a year.
- The fourth period will last the rest of his life and is characterized by the restoration of partial working capacity and the ability to lead a fairly active lifestyle. The person who underwent surgery is required to regularly undergo examinations that will allow you to monitor the process of the new body and constantly support it. In addition, it is absolutely necessary to lead an absolutely healthy lifestyle and follow the diet recommended by doctors.
Considering the fact that this operation is very difficult both in terms of execution and consequences, the risk is quite serious. According to statistics, in the first year about 85% remain alive, then the percentage decreases slightly – to 73%. Usually a new heart works well until the age of seven, but it is much more prone to dystrophy than a healthy one.
Typically, a heart transplant operation lasts no more than 6 hours:
- A heart transplant operation starts from the moment the heart is removed from the donor’s body and immersed in a special fluid. At the same time, preparations are made for the heart transplant operation of the recipient, consisting in the introduction of painkillers and psycholeptics.
- The operation is performed under general anesthesia. First, the front part of the recipient’s chest is opened, and large blood vessels are attached to the heart-lung machine.
- Then the ventricles of the heart are cut off and the atrium is left. This is done so that the sinus node responsible for the rhythm of the contractions of the heart continues to function.
- Then, the recipient of the donor’s atrium is sewn to the atria of the heart and a pacemaker is installed to ensure normal indicators of heart contraction in the postoperative period.
- The chest is sutured and a bandage is applied.
- After the operation, immunosuppressive and cardiotonic measures are taken.
led to a kind of race – who is the first to conduct a heart transplant (a sort of “arms race” in cardiac surgery). The original leaders of the race could be called four to five
in the world. But the most courageous, successful and talented turned out to be Christian Barnard. Became the second
who performed the first heart transplant operation in United States history in 1968. They both underwent clinical residency at the University of Minnesota, but the relationship between them was cold, for which there were reasons.
Shumway despised at Barnard his “ostentatiousness, defiant behavior and readiness to cheat.” Dr. Barnard, in turn, was outraged that Norman seemed to see in him primarily an alien from a second-rate country. In addition, Barnard’s status as a specialist was lower due to the fact that his American colleague had much more extensive experience with heart transplants in animals.
In 1959, Dr. Shumway and Richard Lawer from Stanford University performed the first heart transplant for a dog. An animal with a transplanted heart lived for eight days, and scientists thereby proved to all of humanity that this organ can be transplanted from one animal to another without losing its functionality.
By the end of 1967, Dr. Shumway announced that he was going to begin clinical trials at Stanford, which ultimately should have led him to a heart transplant to a person. Although Shumway believed that animal operations should and will continue, he stated that he had already approached the border beyond which the clinical application of his experience began. It is believed, however, that the American was at a disadvantage because he had difficulty finding donors for the human heart.
Dead brain, living heart
Indeed, at that time, US law forbade the removal of organs from those patients who had a death
but the heart still continued to beat. In order to take the heart, it was necessary that it stopped beating at all. Theoretically, the situation could have been such that a surgeon who neglected these rules would end up in jail for the murder.
Dr. Barnard, on the other hand, acted under the more liberal laws of South Africa. He behaved like a seer, defending such an approach on the part of legislation that allowed a neurosurgeon to ascertain the death of a patient if the latter did not show any reaction to light or pain. And if only the consent of the family or the next of kin of such a patient was obtained, the transplant team could quickly remove the necessary organs, including the heart, through which blood still circulated.
We can say that the rivals had almost equal chances, but Dr. Barnard came to the “finish” first, December 3, 1967. His first patient was a certain Luis Washkanski, a 55-year-old grocer who received the heart of a young woman who died from a traumatic brain injury in a car accident.
In less than a month, Dr. Shumway performed the first heart transplant on the American continent – January 9, 1968. However, a talented surgeon was forced to be satisfied only in second place. His patient, a 54-year-old steelworker, lived 14 days after the transplant. After the patient passed away, Dr. Shumway admitted the presence, as he himself put it, of a “fantastically cosmic amount of complications”.
Basically, the procedure is prescribed to patients with severe heart failure 3-4 stages. They have weakness, tachycardia, severe shortness of breath. Even with a slight load or at rest at the most advanced stages, the prognosis of survival is small, therefore an urgent transplant is necessary.
In addition, the indications for transplantation are as follows:
- Dilated cardiomyopathy.
- Coronary disease, severe myocardial dystrophy.
- The development of a benign tumor in the area of the organ.
- Significant rhythm disturbances that do not respond to medical therapy.
- An abnormality of the heart of a congenital nature that cannot be removed using plastics.
Immediately before the transplant, a blood test is performed, checking the pressure and sugar level. Heart transplantation is performed under general anesthesia and lasts an average of 6 to 10 hours. During this period, the process of cardiopulmonary bypass should be well established.
First, the doctor processes the desired surface and makes a longitudinal section, the chest opens. Through the vena cava the patient is connected to a cardiopulmonary bypass.
Having access to the organ, its ventricles are removed, but the atrium and main vessels are left. At this point, a donor heart is hemmed. Since there are two types of transplantation, depending on the chosen one, the organs are fixed.
When heterotopic, its own organ remains in place, and the graft is placed below to the right of the heart. Next, anastomoses are laid between the chambers and vessels. In this case, two organs can cause compression of the lungs. Basically, the operation is performed in patients with severe hypertension of the small circle.
Obtaining a donor heart is a rather difficult task, therefore transplantation of this organ is performed only as a last resort. There are a number of heart diseases in which transplantation is possible. The following pathologies in the last most severe form will be an indication for such manipulation:
- The last stage of chronic heart failure, in which the patient is severely limited in motor activity, pathological edema of the extremities or even the whole body appears, at this stage shortness of breath is present even at rest.
- Severe heart defects, both congenital and acquired.
- Diseases that cannot be cured by either conservative or surgical methods are severe heart rhythm disturbances, uncontrollable angina.
- Cardiomyopathy, in which structural type changes occur when myocardial fibers are replaced with scar tissue.
- A tumor in the heart.
All such cases of cardiac abnormalities need to be reinforced by the patient’s desire for such surgical intervention, his attitude to lead an absolutely healthy lifestyle and is under the strict control of doctors until the end of his life.
Due to the high cost and some physiological and moral – ethical features, heart transplantology is one of the rarest areas in cardiac surgery.
- These features include:
- A limited number of potential donors.
- A donor can be a person without the presence of cardiac abnormalities and ascertained brain death.
- Limited time donor search.
- The selection of a donor according to waiting lists takes a long period of time, especially during heart transplant surgery in childhood.
- Ethical issue.
- Disapproval by religious organizations of the idea of organ transplants.
- Duration and high cost of rehabilitation measures
- The storage time of donor biomaterial should not exceed 6 hours
Despite these difficulties, operations, albeit in small quantities, have been successfully carried out.
A general indication for which a heart transplant is required is a pronounced decrease in the functions of the heart organ, with the impossibility of conservative treatment and a short life expectancy. With the ineffectiveness of traditional methods of treatment, symptoms – the impossibility of physical activity without the manifestation of symptoms, a significant fluid retention in the body and a violation of the respiratory rate may require a heart replacement.
A condition requiring heart replacement occurs as a result of diseases:
- Hypertrophic cardiomyopathy of the heart.
- Myocardial damage with an increase in heart size. It is expressed in the gradual replacement of the heart muscle cells with connective tissue, which leads to a violation of the heart rhythm. It can be triggered by dilated and ischemic cardiomyopathy.
- Heart defects of different nature
- Tumors of the heart of various nature
- Severe cardiac dysfunction, not amenable to conventional treatment.
In addition to these reasons, the data of complex examinations, which include ultrasound and pulmonary catheterization data, are mandatory taken into account. It can be considered an indication for heart transplantation with a fraction of less than 20% and the absence of severe pulmonary hypertension.
Transplantation cannot be performed if there are contraindications for heart transplant surgery:
- Severe diabetes.
- Human immunodeficiency virus, an active form of tuberculosis.
- The presence of foci of acute infections.
- Acute renal and liver failure.
- Severe forms of impaired immunity.
- Severe form of chronic obstructive pulmonary disease.
- Alcoholism and drug addiction.
- Severe pulmonary hypertension.
- Mental disorders in the active stage.
Most often, transplantation is performed for patients under 65 years of age. A very important factor is the patient’s desire, if it is absent, the procedure is impractical.
In addition, a transplant operation is not recommended for persons with:
- Elevated pressure in the pulmonary artery in excess of 4 units of Wood.
- Infectious diseases in the acute stage, sepsis.
- Connective tissue disease or autoimmune pathology, for example, rheumatism, ankylosing spondylitis, scleroderma, lupus.
- Malignant formation on the heart.
- Chronic pathologies in the stage of decompensation.
- A mental illness when contact with the patient is impossible before and after transplantation.
Absolute contraindications include the abuse of alcohol and smoking, any narcotic substances.
The first studies conducted in the field of heart transplantation began in the fifties of the last century. The successful operations were performed by doctors in South Africa and the United States in the 80s. The first heart transplant in the USSR was carried out in 1988 by V.I. Shumakov. Due to the fact that the immunological basis of the transplant-host reactions were previously insufficiently studied, the quality of life and its duration after surgery did not correspond to the desired results, and the prognosis was uncertain.
At the present stage, the level of knowledge allows carrying out such operations with a minimum risk of complications and with a sufficient life expectancy after a heart transplant (a little less than half of the patients after the operation live more than 10 years).
In some cases, even repeated transplants are possible, for example, one of the richest people in the world according to Forbes magazine, David Rockefeller, at the age of 99 suffered a sixth heart transplant.
- A limited number of donors – people with confirmed brain death, but with a healthy heart,
- The long period of time required to select a donor according to waiting lists, especially for a heart transplant operation for a child,
- Ethical problems, including from a religious point of view, (in particular, a person according to Christian >
However, despite the problems of this kind, operations, although rare, are nevertheless carried out, and very successfully.
The main indication for which a heart transplant is needed is the terminal (final) stage of chronic heart failure (CHF), or its functional class (FC), which is not amenable to treatment with medications, with a prediction of survival in this condition for less than a year.
It is the symptoms characteristic of the last stage (marked limitation of activity, significant swelling of the limbs or the whole body, the appearance of shortness of breath at rest) with the ineffectiveness of conservative therapy may require a transplant of a donor heart.
hypertrophic CMP – the main indication for a heart transplant
Cardiomyopathy (CMP) – structural restructuring of the myocardial fibers, its replacement with scar tissue, leading to impaired contraction and relaxation of the heart muscle, more often the development of heart failure is provoked by dilated and ischemic cardiomyopathy,
Certain conditions must also be observed when planning an operation:
- The age of the recipient (the person to whom the heart will be transplanted) is less than 65 years,
- Patient diligence and desire to follow a further rigorous treatment and follow-up plan.
- Severe pulmonary hypertension (high pressure in the pulmonary artery)
- Severe diabetes mellitus with damage to blood vessels, kidneys, retina,
- HIV infection, active tuberculosis process,
- Acute infectious diseases
- Severe renal and hepatic failure,
- Systemic autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, etc.),
- Severe chronic obstructive pulmonary disease,
- Alcohol or drug addiction,
- Oncological diseases,
- Mental illness in the acute stage.
Attempts to transplant organs were made back in the middle of the last century, however, insufficient equipment, lack of knowledge of some immunological aspects, lack of effective immunosuppressive therapy made the operation not always successful, organs did not take root, and recipients died.
The first heart transplant was performed half a century ago, in 1967, by Christian Barnar. It was successful, and a new stage in transplantology began in 1983 with the introduction of cyclosporin into practice. This drug allowed to increase the survival rate of the organ and the survival of the recipients. Transplants began to be carried out around the world, including in Russia.
The main problem of modern transplantology is the lack of donor organs, often not because they are physically absent, but due to imperfect legislative mechanisms and insufficient public awareness of the role of organ transplants.
It happens that the relatives of a healthy person who died, for example, from injuries, is categorically against agreeing to take organs for transplantation to needy patients, even being informed about the possibility of saving several lives at once. In Europe and the USA, these issues are practically not discussed, people voluntarily give such consent during their lifetime, and in post-Soviet countries, specialists have yet to overcome a serious obstacle in the form of ignorance and unwillingness of people to participate in such programs.
Among the diseases that lead to heart failure and can become indications for heart transplantation, indicate:
- Dilated cardiomyopathy;
- Severe ischemic disease with severe myocardial dystrophy;
- Congenital organ abnormalities that cannot be corrected by plastic surgery on the heart;
- Benign neoplasms of the heart;
- Malignant rhythm disturbances that do not respond to other methods of treatment.
Early postoperative period:
- Bleeding and infections. When bleeding occurs, the incision site is opened and the source (place) of bleeding is sutured. To prevent infectious complications, antibiotics are prescribed and immunosuppression is performed.
Late postoperative period:
- There is a likelihood of rejection of the graft and disruption of the normal functioning of the coronary arteries leading to the development of coronary artery disease.
If the first occurs, the wound is opened again and a bleeding vessel is sutured. To prevent the development of infections of a bacterial, viral or fungal nature, antibiotics and immunosuppression are prescribed.
In addition, an oncological illness in the form of lymphoma or myeloma can develop, immunosuppressors contribute to this, since they suppress the immune system. Ischemia can occur if the organ was not implanted immediately, but more than 4 hours after extraction from the donor body.
In addition, after surgery, you may experience:
- Increased pressure on the heart, this is due to the amount of fluid in the space around the organ.
- Irregular heartbeat.
- Lower cardiac output.
- Increase or decrease in blood volume in the circulatory system.
Half of the patients develop coronary artery disease within 1-5 years after surgery.
It is possible to suspect in the postoperative period that something went wrong with the appearance of:
- Pain in the sternum, shortness of breath.
- Severe cough.
- Migraines and dizziness on an ongoing basis.
- High temperature.
- Arrhythmias combined with nausea and vomiting.
- Coordination disorders.
- Increased or decreased blood pressure, worsening overall well-being.
Heart transplantation is considered a very complex operation. The main difficulty lies in the lack of a donor organ for a quota, and half of the patients die, without waiting for it.
In addition, even if the patient was operated on time, organ rejection or wound infection can occur, which can lead to death. Nevertheless, transplantation is very often the only salvation for patients with severe heart pathologies. And if everything went well, the recipient receives a new page in his life from 1 year to 11 years, and sometimes more.
How to make a transplant is understandable, but it is worth highlighting the possible complications that take place. The patient should be informed that rejection, infection of the coronary arteries can occur. There are frequent cases of infection, pneumonia, the formation of blood clots and bleeding. Particularly dangerous consequences include:
- decreased brain function;
- damage to other organs (kidneys);
- problems with anesthesia;
Many are interested in the issue of heart transplantation – how many live? Given the complexity of the process, the consequences are most unpredictable. Now the number of deaths in the first period has decreased significantly, and such people live for 10 and 30 years. Even cases are known where a child received a heart transplant, and this saved his life.
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How much does a heart transplant cost is difficult to say for sure, because it depends on many factors. But to accurately describe what happens after this is quite possible.
It is logical that the procedure is carried out in a stationary mode, the length of stay in the hospital is on average two weeks, sometimes more. Recovery in the hospital involves deep breathing and coughing 10-20 times every hour, taking immunosuppressants. They help reduce the chance of foreign body rejection. Home care consists in taking prescribed medications, regular visits to a cardiologist, physiotherapy.
There is even a book by Ray Bradbury, Heart Transplant, but it’s not entirely about surgery, but rather about love.
A heart transplant operation is not the final stage of treatment, but the beginning of a new life. And this life is far from as simple as it might seem. Indeed, in order for the new heart to continue to beat, you need to make considerable efforts. About how many people can live after a successful heart transplant, you will learn from this article.
The most common complications that occur in the first year after a heart transplant include rejection of a donor organ. It arises due to the fact that the patient’s immunity rejects foreign tissue.
At an early stage, heart rejection can occur without severe symptoms. Therefore, it is important for patients to be under the supervision of doctors: the sooner they can recognize rejection, the more successful the treatment will be.
Symptoms of rejection vary greatly. The first manifestations of this complication are:
- low-grade fever
- headaches and joint pain
- drowsiness, breakdown
Such symptoms can easily be mistaken for signs of an approaching flu.
There may be more non-specific symptoms, such as nausea, vomiting, indigestion.
The most accurate rejection diagnosis method is a biopsy. Rejection treatment consists of taking high doses of glucocorticosteroids, carrying out plasmophoresis and other measures aimed at suppressing the immune system and eliminating toxins from the body.
Another common complication that occurs after a heart transplant is bacterial and viral infections, which are the result of suppressing the patient’s immune system.
After the first year of life with a donor heart, the risk of developing rejection and infectious diseases is sharply reduced. However, the patient may experience other serious complications, the most common of which is narrowing of the lumen of the coronary arteries. Coronary insufficiency ranks first among all the causes of death in the later stages after surgery.
The problem of narrowing of the coronary arteries was identified only after it was possible to overcome the problem of early postoperative complications. At the moment, the disease is successfully managed. It is possible to save a patient’s life only if an early diagnosis of vasoconstriction occurs.
Unfortunately, the causes of the complication have not yet been identified. It is predicted that an understanding of the mechanism of development of narrowing of the coronary vessels will help develop methods for the prevention of this complication.
A heart transplant from person to person was first done in 1967 in South Africa, the operation was performed by Dr. Christian Bernard, the patient lived 18 days.
Starting from the seventies of the last century, doctors constantly tried to transplant one person’s heart to another, but the main problem was the rejection of the recipient, an organ alien to him, by the body. Everything changed when the drug cyclosporin was invented, which just the same prevents rejection. After that, heart transplant operations, in the terminal stage of myocarditis, cardiomyopathy, etc., began to be performed often and for the most part successfully.
There are a number of risk factors that could jeopardize the success of an operation:
- Age over 60 years.
- If the patient is on mechanical ventilation.
- When the patient has a high level of C-reactive protein in the blood.
- If there have already been heart transplants.
- A history of hypertension is noted.
However, even in such adverse conditions, 95 out of 100 operations are successful. And if the patient survives the first 30 days, then the chance that he will live another year approaches 90%.
Heart transplant surgery: indications, conduct, prognosis and rehabilitation
The postoperative prognosis is positive – 90% of the operated on live more than one year, 60% – more than five years, and about half of the total operated can live more than 10 years.
Having decided on transplantation, the patient is naturally concerned with the question of how much they live after a heart transplant. Each case is individual and depends on the following factors:
- gender – according to medical statistics, the chances of survival in women are slightly lower than in men;
- general condition of the patient at the time of intervention;
- immunological compatibility of the donor and recipient;
- body reaction to a new organ, degree of heart rejection.
In world practice, the following figures are given:
- 1 year after surgery – about 90% of patients survive;
- 3 years – 77% of men and 75% of women;
- 5 years – 73% of men and 67% of the fair sex.
Currently, one of the first transplant patients has celebrated a peculiar anniversary in the USA. The man lived a quarter century with a donor organ. Currently, the hero of the anniversary is 78 years old.
The chances of transplant success are reduced by the following factors:
- age from 65 years;
- the impossibility of independent breathing before and after the intervention;
- rejection reaction began;
- This is not the first surgical intervention on the organ.
According to statistics, 95% of surgical interventions are successful. The first month with a new heart is decisive and according to its results the specialist will give a final forecast. If the patient lived 30 days after the operation, then the probability of having a new year in good health is 90%.
How much does a heart transplant cost
All citizens of the Russian Federation have the right to free high-tech medical care, which includes transplant operations. Based on this, with a suitable heart, it will not cost the patient anything. But, in addition to heart transplant surgery, the patient expects a long and expensive rehabilitation.
According to the legislative act on the ban on organ trafficking, adopted around the world only cadaveric and related transplantation is allowed. Thanks to this, only the cost of the most surgical intervention of medicines before and after the operation and rehabilitation enterprises is paid. The heart itself is not paid.
Typically, the cost of heart transplant surgery is 250 thousand dollars, but it can reach half a million.
The Russian center, which carries out the selection of donor organs, operates in the capital of our country. Heart transplant operations are carried out in specialized centers in Moscow, Novosibirsk and St. Petersburg.
Now in the Russian Federation there is no detailed legislative framework regulating the basic principles of tissue transplantation. This is one of the reasons for the rarity of this type of operation – in 2014, only 200 were performed, and, for example, in the United States over the same period of time, 28 thousand were performed.
Also, gaps in the principles of organ transplantation for children, in particular the ban on organ removal from patients under 18 years of age, necessitated treatment abroad. Only in 2015, a legislative act was passed on the procedure for stating brain death in people older than 1 year. Which opens up opportunities for improving the regulatory framework in the field of child donation.
In Russia there is only one single coordinating center, which carries out the selection of donors, operating on the territory of Moscow and the Moscow region. Direct heart transplantation is carried out in:
- Federal Scientific Center for Transplantology and Artificial Organs named after V. I. Shumakova in Moscow, (FSBI “Federal Scientific and Technical Center named after V. I. Shumakov”),
- Scientific Research Institute of Circulatory Pathology E.N. Meshalkina in Novosibirsk,
- FSBI North-West Federal Medical Research Center named after V. A. Almazova ”in St. Petersburg.
Due to the fact that the legislative principles of organ donation are not fully developed in our country, heart transplant operations are rarely performed, for example, in 2014, only 200 operations were performed, while in the United States about 28 thousand transplant operations were performed . For the same reason (the ban on organ harvesting from patients under the age of 18), children in need of a heart transplant required expensive treatment abroad (Italy and India).