What is a heart transplant?

A heart transplant is surgery to remove the diseased heart from a person and replace it with a healthy one from an organ donor. To remove the heart from the donor, two or more healthcare providers must declare the donor brain-dead.

Before you can be put on a waiting list for a heart transplant, a healthcare provider makes the decision that this is the best treatment choice for your heart failure. A healthcare team also makes sure you are otherwise healthy enough to go through the transplant process.

Why might I need a heart transplant?

You may need a heart transplant if your heart is failing and other treatments are not effective.

End-stage heart failure is a disease in which the heart muscle is failing severely in its attempt to pump blood through the body. It means other treatments are no longer working. End-stage heart failure is the final stage of heart failure. Despite its name, a diagnosis of heart failure does not mean the heart is about to stop beating. The term failure means the heart muscle is failing to pump blood normally because it is damaged or very weak, or both.

Some causes of heart failure include:

  • Heart attack(myocardial infarction or MI)
  • Viral infection of the heart muscle
  • High blood pressure
  • Heart valve disease
  • Heart defects present at birth(congenital)
  • Irregular heartbeats (arrhythmias)
  • High blood pressure in the lungs (pulmonary hypertension)
  • Alcoholism or drug abuse
  • Chronic lung diseases, such as emphysemaor chronic obstructive pulmonary disease (COPD)
  • Heart muscle is enlarged, thick, and stiff (cardiomyopathy)
  • Low red blood cell count (anemia)

Your healthcare provider may have other reasons to recommend a heart transplant.

What are the risks of a heart transplant?

As with any surgery, complications may occur. Potential risks of a heart transplant may include:

  • Infection
  • Bleeding during or after the surgery
  • Blood clots that can cause heart attack, stroke, or lung problems
  • Breathing problems
  • Kidney failure
  • Coronary allograft vasculopathy (CAV). This is a problem with the blood vessels that carry blood to the heart muscle itself. They become thick and hard. This can cause serious heart muscle damage.
  • Failure of the donor heart
  • Death

Your body’s immune system may reject the new heart. Rejection is your body’s normal reaction to a foreign object or tissue. When you get a new heart, your immune system reacts to what it sees as a foreign threat and attacks the new organ. To allow the transplanted organ to survive in a new body, you will need to take medicines. The medicines will trick the immune system into accepting the transplant and keep it from attacking it.

You will need to take the medicines to prevent or treat rejection for the rest of your life. These drugs have side effects too. The side effects will depend on the specific medicines you take.

  • Current or repeated infection that does not get better with treatment
  • Poor blood circulation throughout the body, including the brain
  • Metastatic cancer. This is when cancer has spread from the place it started to one or more other places in the body.
  • Severe health problems that would make you unable to tolerate the surgery
  • Serious health problems other than heart disease that would not get better after transplant
  • Noncompliance with treatment regimen. For instance, not following your healthcare provider’s directions, not taking medicines as prescribed, or missing appointments.
  • Drug or alcohol abuse

There may be other risks depending on your specific health condition. Be sure to discuss any concerns with your healthcare provider before the surgery.

How do I get ready for a heart transplant?

Not everyone is a candidate for heart transplant. Because of the wide range of information needed to know if a person is eligible for transplant, a transplant team will review the evaluation. The team includes a transplant surgeon, a transplant cardiologist (doctor specializing in the treatment of the heart), nurse practitioners or physician assistants, one or more transplant nurses, a social worker, and a psychiatrist or psychologist. Other team members may include a dietitian, a chaplain, hospital administrator, and an anesthesiologist (doctor who uses medicines to keep you asleep during surgery).

The transplant evaluation process will include:

  • Psychological and social evaluation. Some psychological and social issues that are involved in organ transplant include stress, financial issues, and support from family or significant others. These factors can greatly affect how you do after the transplant.
  • Blood tests. You will need blood tests to help find a good donor match and help improve the chances that the donor heart will not be rejected.
  • Diagnostic tests. You will needtests to assess your lungs as well as your overall health. These tests may include X-rays, ultrasound procedures, CT scan, pulmonary function tests (PFTs), and dental exams. Women may get a Pap test, gynecology evaluation, and a mammogram.
  • Other preparations. You will get several vaccines to decrease the chances of developing infections that can affect the transplanted heart.

The transplant team will consider all the information from interviews, your health history, the findings from your physical exam, and your diagnostic test results when deciding if you are eligible for a heart transplant.

Once you have been accepted as a transplant candidate, you will be placed on the United Network for Organ Sharing list. When a donor organ becomes available, candidates are selected based on the severity of their condition, body size, and blood type. If the heart is to be yours, you will need to go to the hospital right away so you can get ready for the transplant. (Most hearts must be transplanted within 4 hours after they’ve been removed from the donor.)

These things will need to be done before the transplant:

  • Your healthcare provider will explain the procedure and let you ask questions.
  • You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if anything is unclear.
  • You should not eat or drink anything (fast) as soon as you have been told that a heart has become available.
  • You may be given medicine to help you relax (sedative).
  • Based on your health condition, your healthcare provider may request other specific preparation.