• About heart transplantation

    Heart transplantation is a surgical procedure that allows doctors to remove a diseased or failing heart muscle and replace it with a donated healthier heart. Heart transplants are usually a last resort after other medical approaches have been attempted. Common approaches include medications, surgical procedures or placement of assistive devices like a VAD.

    Even though a heart transplant is a major surgery, chances of survival are good and quality of life is also positive provided that the patient takes steps to maintain the health of the new heart.

  • Why would I need a heart transplant?

    A heart transplant may be used when other medical approaches have not worked and the heart muscle or components of the heart are unable to work as they should. Heart failure in adults can be caused by coronary artery disease, cardiomyopathy, valve disease or problems from a congenital/birth defect. Criteria for a heart transplant will vary slightly depending on the facility where your transplant is taking place there are a few circumstances that may prevent approval for a transplant:

    • irreversible pulmonary hypertension/elevated pulmonary vascular resistance
    • systemic infection
    • a history of cancer with a high likelihood of recurrence, or current cancer
    • refusal or an inability to keep the donor heart healthy (taking medications as ordered, not smoking, following a healthy lifestyle)
    • severe blockages in the blood vessels of your arms or legs
    • presence of organ failure elsewhere in the body, especially failure that may shorten life

    If you aren’t a candidate for a heart transplant, there may still be hope with the use of a ventricular assist device (VAD). These devices are surgically implanted and can help one or both lower chambers of the heart pump blood more effectively. Some patients may be fitted with a VAD while they are waiting for a transplant, but many others are using them as a long-term or permanent solution with very good results.

  • Complications

    The most common complication of a heart transplant is rejection. Because the donor heart comes from someone else, the recipient’s immune system sees the heart as a foreign object and works to remove it from the body in the same way it would fight a bacteria or virus. Patients who have a heart transplant are placed on medication to keep the immune system suppressed and it is very important that the medications are taken every day, but even with it up to 25% of patients will show signs of rejection in the first year.

    Not all signs will trigger failure of the new heart and may only require adjustments in medication. To ensure the heart is working as it should, patients will have biopsies of the heart regularly in the months following placement. To biopsy the heart, doctors run a small tube up through the groin or down through a vein in the neck to the heart where a small sample of tissue is collected and tested. As time passes, patients have fewer and fewer biopsies as the risk for rejection lessens.

    Additional complications

    Because immunosuppressant medications will be needed for the rest of the patient’s life, other complications may arise including a higher risk for cancers of the skin and lip, non-Hodgkin’s lymphoma and others. Kidneys may show damage over time from processing these medications as well and various infections may develop causing the patient to be readmitted to the hospital for treatment.

    Occasionally after a transplant, the arteries that feed the heart muscle itself can harden and thicken. Known as cardiac allograft vasculopathy (CAV), the condition can restrict blood flow to the heart attack, heart failure or even sudden death.

  • Preparing for transplant

    Preparing for a transplant can be a long process. The first step is locating a transplant center who will help coordinate your care and place a donor heart when it is located. Most patients can choose where they would like to go for their transplant, but it is a good idea to check with your insurance company too.

    Once you are approved for a transplant and meet criteria, you will be placed on a waiting list. During this time, you will be monitored to make sure you stay healthy enough and still meet criteria for a transplant. If you should get an infection or complication, your name will be removed from the donor list until you heal and then be placed back on.

    When a donor heart is located the transplant center will notify you. In some cases, you will be given a cell phone or pager that must be kept on at all times. Because a heart needs to be placed within four hours of removal from the donor, it is very important for the recipient to be ready to come to the hospital at a moment’s notice. It’s a good idea to have a bag packed with all you will need and keep it by the door.

  • About the surgery

    The surgery itself takes about 4 hours or longer if there is scar tissue to remove or a complication arises. To start, the doctor will open the chest and place the patient on a heart-lung bypass machine that will keep oxygen flowing to the body. The patient’s old heart is then removed and the new heart is sewn into place. The new heart usually starts beating when blood flow returns, but sometimes the heart needs a little shock to get it going.

    Once the heart is beating correctly and shows no signs of leakage, the chest is sewn shut. There will be a significant amount of pain after the surgery but this is treated with medication and patients are kept as comfortable as possible. Some patients will need a ventilator to help them breathe temporarily and may have tubes in their chest to drain fluid away from the new heart and lungs.