How does heart transplant surgery work? - Roni Shanoada

Prevodilac: Jovana Babic Lektor: Milenka Okuka

Your heart beats more than 100,000 times a day.

Vaše srce kuca više od 100 000 puta dnevno.

In just a minute, it pumps over five liters of blood throughout your body.

U toku jednog minuta, ono ispumpa preko pet litara krvi kroz vše telo.

But unlike skin and bones, the heart has a limited ability to repair itself.

Ali za razliku od kože i kostiju, srce ima oraničenu mogućnost reparacije.

So if this organ is severely damaged,

Zbog toga, ako je ovaj organ ozbiljno oštećen

there’s often only one medical solution: replacing it.

često postoji samo jedno medicinsko rešenje: zameniti ga.

Today, nearly 3,500 heart transplants are performed each year

Danas, skoro 3 500 transplantacija srca se izvodi svake godine

in a complex and intricate procedure with no room for error.

pomoću kompleksne i zamršene operacije bez mesta za grešku.

The process begins by testing potential recipients

Proces započinje testiranjem potencijalnih primaoca

to ensure they’re healthy enough for this demanding operation.

da bi se utvrdilo da li su dovoljno zdravi za ovu zahtevnu operaciju.

Doctors are especially concerned with identifying immunocompromising illnesses

Doktori posebno obraćaju pažnju na imunodeficijentne bolesti

or any other conditions that could compromise a patient's chance of survival.

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.

Sledeći korak je povezati kvalifikovanog primaoca sa davaocem organa.

Donors are often comatose patients with no chance of being resuscitated

Davaoci su često pacijenti u komi koji nemaju šansu za buđenje

or victims of a fatal event whose hearts are still healthy.

ili žrtve smrtonosnih događaja čija su srca i dalje zdrava.

In both cases, these patients need to be registered as an organ donor

U oba slučaja, ovi pacijenti moraju biti registrovani kao davaoci organa

or have their families give consent.

ili njihove porodice moraju pristati na proceduru.

And even when a heart is available,

A čak i kada je srce dostupno,

surgeons can’t just pair any donor with any recipient.

hirurzi ne mogu spojiti bilo kog davaoca sa bilo kojim primaocem.

The recipient’s immune system will view a transplanted heart

Imuni sistem primaoca će posmatrati srčani transplant

as a foreign organism that must be attacked.

kao strani organizam koji mora napasti.

So doctors need to match recipients with donors that share their blood type

Zbog toga doktori moraju da povežu primaoce sa davaocima iste krvne grupe

and have similar antigens.

kao i one sa sličnim antigenima.

If a match can be made, the surgery can begin.

Ako su oba učesnika kompatabilni, operacija može da počne.

Once the donor's heart is confirmed to be healthy,

Kada se utvrdi da je donorovo srce zdravo,

the organ is immersed in an ice slush

ono se stavlja u ledenu ,,bljuzgavicu”

and injected with a solution to induce cardiac arrest.

i daje mu se rastvor koji izaziva srčani zastoj.

These treatments stop the heart from pumping

Ovo se radi da bi srce prestalo da kuca

to ensure it can be removed cleanly.

i da bi moglo sigurno da se ukloni.

Surgeons then place the organ in a mix of cold saline

Hirurzi zatim stavljaju organ u mešavinu hladnog fiziološkog rastvora

and preservation solution.

i rastvora za prezervaciju.

This is when the clock starts.

Ovog trenutka sat počinje da otkucava.

Disconnected from its blood supply,

U stanju bez krvi,

the heart’s cells start taking on damage from lack of oxygen.

srčane ćelije bivaju oštećene zbog manjka kiseonika.

The organ will only remain viable outside the body for a few hours,

Organ u ovom stanju će ostati održiv izvan tela svega nekoliko sati,

so it needs to reach its recipient as fast as possible.

zbog čega mora stići do primaoca što je pre moguće.

Once the heart arrives, the recipient is put under general anesthesia.

Kada srce stigne, primalac se stavlja pod opštu anesteziju.

The surgeon makes an incision down the length of the chest,

Hirurg pravi rez duž grudi,

cutting through the breastbone to separate the rib cage

seče grudnu kost da bi razdvojio grudni koš

and expose the heart.

i otkrio srce.

To keep blood flowing while they remove the damaged organ,

Da bi krv cirkulisala dok se oštećeni organ uklanja,

surgeons use a cardiopulmonary bypass machine.

hirurzi koriste mašinu za kardiopulmonalni bajpas.

This takes over the heart's job,

Ona preuzima posao srca

generating enough force to push blood through the patient's circulatory system.

i stvara dovoljno jaku silu koja gura krv kroz krvne sudove pacijenta.

After the old heart is removed,

Nakon što se staro srce ukloni,

the surgeon begins sewing the donor heart into place.

hirurg počinje da ušiva srce davaoca na mesto.

This is an incredibly precise process, where each blood vessel and artery

Ovo je veoma precizan proces gde se svaki krvni sud i arterija

must be carefully attached to avoid leaks.

moraju pažljivo povezati da bi se izbeglo curenje.

The procedure can last several hours,

Operacija može da traje nekoliko sati,

potentially longer if there’s scar tissue from previous surgeries.

ponekad i duže ako postoji ožiljno tkivo zaostalo od prethodnih operacija.

Once it’s finished, the bypass machine is turned off

Kada je sve gotovo, mašina za bajpas se gasi

and blood is allowed to flow into the aorta.

i krv ulazi u aortu.

Doctors carefully monitor the new heart to ensure it’s beating on its own

Doktori pažljivo posmatraju novo srce da bi se uverili da samostalno kuca

before sewing the recipient back up.

pre nego što zašiju pacijenta.

Even after the procedure is complete, there's still work to be done.

Čak i nakon operacije, posao nije gotov.

Surgeons are unable to directly connect the heart

Hirurzi nisu u stanju da direktno povežu srce

to the recipient’s nervous system,

sa nervnim sistemom primaoca,

and it can take years for the body to fully innervate the new organ.

a potpuna inervacija novog organa može potrajati godinama.

During this period, the transplanted organ has a higher resting heart rate

Tokom ovog perioda, transplantirani organ ima višu frekvencu u mirovanju

and risk of stroke, making exercise difficult and dangerous.

i veći rizik od srčanog udara, što otežava i ugrožava pacijenta za vreme vežbanja.

And since it’s incredibly rare to find a perfect match

Takođe, pošto je potpuno podudaranje između donora i primaoca

between donor and recipient,

neverovatno retko,

the immune system will also have some response to the new heart.

imuni sistem će takođe reagovati na novo srce.

Immunosuppressive drugs can help manage the risk of rejection,

Imunosupresivni lekovi mogu da smanje rizik od odbacivanja,

but they also leave patients open to contracting dangerous infections.

ali takođe čine pacijente podložnijim opasnim infekcijama.

It requires constant monitoring and testing to balance these two concerns.

Zbog toga, ova dva problema zahtevaju konstantno nadgledanje i testiranje.

Despite these challenges, about 70% of heart transplant recipients survive

Uprkos ovim izazovima, oko 70% primalaca stransplanta živi

for at least five years after the operation,

minimum pet godina nakon operacije,

and just over 20% live another 20 years.

a oko 20% živi dodatnih 20 godina.

So when this procedure is successful, it's truly lifesaving.

Dakle, kada je ova operacija uspešna, ona zaista spasava život.

Unfortunately, people in developing countries are often unable

Na žalost, ljudi iz zemalja u razvoju često nisu u mogućnosti

to access this surgery,

da dobiju pristup ovoj operaciji,

and many viable hearts can’t be donated due to legal and regulatory issues.

a mnogi pogodni organi se ne mogu donirati zbog pravnih problema i regulacija.

Thousands of people remain on waiting lists,

Hiljade ljudi ostaje na listama čekanja,

and many are never able to find a suitable donor.

a mnogi od njih nikad neće uspeti da nađu odgovarajućeg donora.