Patient Basics: Heart Transplant

Originally published by Harvard Health.

What Is It?

A heart transplant is surgery in which a patient with a life-threatening heart problem receives a new, healthy heart from a person who has died. In a heart transplant, the patient who receives the new heart (the recipient) is someone who has a 30 percent or greater risk of dying within 1 year without a new heart. Although there is no absolute age limit, most transplants are performed on patients younger than 70 years old.

The person who provides the healthy heart (the donor) is usually someone who has been declared brain dead and is still on life-support machinery. Heart donors are usually younger than 50, have no history of heart problems, and do not have any infectious diseases.

The recipient and donor must be a good match, meaning that certain proteins on their cells (called antigens) are similar. A good match will reduce the risk that the recipient’s immune system will see the donor heart as a foreign object and attack it in a process called organ rejection.

Surgeons perform about 2,200 heart transplants each year in the United States. More than 3,000 people remain on the national waiting list for a donor heart. At these rates, up to 15 percent of patients on the waiting list will die before a suitable heart is found.

What It’s Used For

A heart transplant treats irreversible heart failure when other treatment options fail. In the United States, heart transplants are performed for several types of cardiac illness, including:

• Severe coronary artery disease
• Cardiomyopathy, an illness that damages the heart muscle
• Congenital heart disease
• Irreparably damaged heart valves
• A second transplant after a first heart transplant fails

Preparation

To get a heart transplant, you must meet certain requirements. Although these requirements vary slightly from program to program, the typical heart transplant candidate usually fits the following profile:

• Is younger than 70
• Likely to die within 1 year without a heart transplant
• Have no other potentially life-threatening medical problems except for heart disease. Problems that can disqualify a candidate include significant irreversible kidney, lung, or liver disease, HIV, pneumonia or another active infection, cancer, or a history of stroke or significant circulatory problems.
• Is emotionally stable
• Is willing to follow the rigorous program of lifestyle changes and medication that is necessary after a heart transplant

Preparing for a heart transplant includes getting a thorough cardiac evaluation with a chest X-ray, electrocardiogram (EKG), heart catheterization, echocardiogram and a heart biopsy. Blood tests will be done to evaluate kidney function and check for anemia and other blood problems and rule out viral illnesses such as HIV, hepatitis, herpes simplex virus and cytomegalovirus. Blood also is drawn for blood typing and tissue typing (used to find a donor match).

If you smoke cigarettes or have problems with drug or alcohol abuse, you may be required to complete a substance-abuse treatment program before you will be considered a possible candidate for a heart transplant.

You will meet regularly with members of the transplantation team. These specialists offer a wide range of support aimed at helping you through the long period before your transplant. For most patients, the waiting time is at least 12 months.

How It’s Done

A nurse will insert an intravenous (IV) line into a vein in your arm to deliver fluids and medications, and you will be given anesthesia to make you unconscious. After your surgeon inspects the donor heart to confirm that it looks healthy and suitable for transplantation, he or she will make a large incision in the middle of your chest. You will be placed on a heart-lung machine, which pumps your blood during surgery.

The surgeon removes your failing heart, then positions the donor heart in your chest and sutures (sews) it in place. Your new heart was cooled to preserve it before transplantation. As it warms up to room temperature, it might begin to beat on its own. If not, the surgeon may trigger your heart to start beating with an electric shock.

Once your new heart pumps steadily without leaks, the surgical team disconnects you from the heart-lung machine and stitches your chest closed. You are then taken to the intensive care unit for monitoring.

You will probably be in the intensive care unit for at 2 to 3 days. Next, you will to a regular hospital room with close monitoring. You can expect daily blood tests and frequent echocardiograms until you are stable enough to go home. The total hospital stay is about 10 days.

Follow-Up

Before you leave the hospital, your doctor will prescribe several medications to help prevent infections and reduce the risk that your body will reject your new heart. You will also receive a schedule for follow-up visits. You can expect to have an echocardiogram, blood tests and a heart biopsy (the removal of a piece of heart tissue) about every 7 to 10 days during the first 1 to 2 months after your transplantation, then every 14 days for the next 2 to 4 months.  If all goes well, the tests and biopsies will need to be performed less frequently.

If you have any questions, concerns or unexpected symptoms after your transplant, contact the transplantation team at any hour of the day or night.

Risks

Survival rates are slightly higher for males compared to females. More than 75% of heart transplant recipients are alive 3 years after their surgery. About 70% survive for 5 or more years. The leading cause of death is infection, not organ rejection. With proper medical treatment to suppress the immune system, most patients can avoid signs of rejection during the first year after transplantation.

When To Call a Professional

After your discharge, call your doctor immediately if:

• You develop chest pain, shortness of breath, dizziness or an irregular heartbeat.
• You have a fever.
• Your incision becomes red, swollen and painful, or it oozes blood.

Additional Info

United Network for Organ Sharing (UNOS)
P.O. Box 2484
Richmond, VA 23218
Toll-Free: 1-888-894-6361
http://www.unos.org/

National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: 301-592-8573
TTY: 240-629-3255
Fax: 240-629-3246
http://www.nhlbi.nih.gov/