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 to 70 percent risk of dying within one year without a new heart. 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 in terms of specific chemical characteristics (called antigens) found on their cells. 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 — a process called organ rejection.

Currently, surgeons perform 2,300 to 2,500 heart transplants each year in the United States. More than 4,000 people remain on the national waiting list for a donor heart. At these rates, up to 30 percent of patients on the waiting list will die before a suitable heart is found. Potential donor hearts are located through an organization called the United Network for Organ Sharing (UNOS).

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 (about 45 percent of cases)
• Cardiomyopathy, an illness that damages the heart muscle (42 percent)
• Congenital heart disease (7 percent to 8 percent)
• Irreparably damaged heart valves (2 percent)
• A second transplant after a first heart transplant fails (about 3 percent)

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

• Is younger than 60, but likely to die within one year without a heart transplant
• Has no other potentially life-threatening medical problems except for heart disease. Problems that can disqualify a candidate include significant kidney disease, HIV, pneumonia or another active infection, cancer, a history of stroke or significant circulatory problems affecting the brain, and severe type 1 (insulin-dependent) diabetes.
• 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, echocardiography and a heart biopsy. Blood tests 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 is also 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 must complete a substance-abuse treatment program before receiving your new heart.

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, waiting time is at least 12 months.

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 surgeons removes your failing heart, then positions the donor heart in your chest and sutures 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.

After two or three days in the intensive care unit, you can move to a private room. You will continue to be monitored, and will get daily blood tests and echocardiograms until you are stable enough to go home. The total hospital stay is usually 10 to 14 days.

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 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) every seven to 10 days during the first month after your transplantation, then every 14 days during the second month. If all goes well, you will need these tests monthly during months three through six, then once every three months for the rest of your life.

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

Currently, about 85 percent of all heart transplant patients survive for one year after surgery, 76 percent survive for three years, 64 percent for five years and 45 percent for 10 years. The leading cause of death is infection, not organ rejection. With proper medical treatment to suppress the immune system, at least 86 percent of patients can avoid signs of rejection during the first year after a transplantation.

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

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.