heart and lungs of the patient. The patient is connected to a heart–lung machine, which circulates and oxygenates blood. The surgeon removes the failing heart and lungs. Most surgeons endeavour to cut blood vessels as close as possible to the heart to leave room for trimming, especially if the donor heart is of a different size than the original organ. The donor heart and lungs are positioned and sewn into place. As the donor organs warm up to body temperature, the lungs begin to inflate. The heart may fibrillate at first – this occurs because the cardiac muscle fibres are not contracting synchronously. Internal paddles can be used to apply a small electric shock to the heart to restore proper rhythm. Once the donor organs are functioning normally, the heart–lung machine is withdrawn, and the chest is closed. Post-operation Most patients spend several days in intensive care after the operation. If there are no complications (e.g. infection, rejection), some are able to return home after just two weeks in hospital. Patients will be given anti-rejection drugs, and antibiotics to prevent infection, this weakens the immune system. A schedule of frequent follow up visits is necessary. Statistics The success rate of heart–lung transplants has improved significantly in recent years. The British National Health Service states that the survival rate is now around 85%, one year after the transplant was performed. In 2004, there were only 39 heart–lung transplants performed in the entire United States and only 75 worldwide. By comparison, in that same year there were 2,016 heart and 1,173 lung transplants. See also Organ transplant Heart transplantation Lung transplantation References External links National Heart, Lung and Blood Institute (NHLBI) Photograph of first successful heart–lung transplant Organ transplantation Cardiac surgery Pulmonary thoracic surgery Lung Transplant Lung