What Is a Heart Transplant?

A heart transplant is surgery to remove a person's diseased heart and replace it with a healthy heart from a deceased donor. Most heart transplants are done on patients who have end-stage heart failure.

Heart failure is a condition in which the heart is damaged or weak. As a result, it can't pump enough blood to meet the body's needs. "End-stage" means the condition is so severe that all treatments, other than a heart transplant, have failed.

Overview

Heart transplants are done as a life-saving measure for end-stage heart failure.

Because donor hearts are in short supply, patients who need heart transplants go through a careful selection process. They must be sick enough to need a new heart, yet healthy enough to receive it.

Survival rates for people receiving heart transplants have improved, especially in the first year after the transplant.

About 88 percent of patients survive the first year after transplant surgery, and 75 percent survive for 5 years. The 10-year survival rate is about 56 percent.

After the surgery, most heart transplant patients can return to their normal levels of activity. However, less than 30 percent return to work for many different reasons.

The Heart Transplant Process

The heart transplant process starts when doctors refer a patient who has end-stage heart failure to a heart transplant center.

Staff members at the center assess whether the patient is eligible for the surgery. If the patient is eligible, he or she is placed on a waiting list for a donor heart.

Heart transplant surgery is done in a hospital when a suitable donor heart is found. After the transplant, the patient is started on a lifelong health care plan. The plan involves multiple medicines and frequent medical checkups.

Most patients referred to heart transplant centers have end-stage heart failure. Their heart failure might have been caused by:

• Coronary heart disease.
• Hereditary conditions.
• Viral infections of the heart.
• Damaged heart valves and muscles. (Alcohol, pregnancy, and certain medicines can damage the heart valves and muscles.)

Most patients considered for heart transplants have tried other, less drastic treatments. They also have been hospitalized many times for heart failure.

Who Is Eligible for a Heart Transplant?

The specialists at the heart transplant center will assess whether a patient is eligible for a transplant. Specialists often include a:

• Cardiologist (a doctor who specializes in diagnosing and treating heart problems)
• Cardiovascular surgeon (a doctor who does the transplant surgery)
• Transplant coordinator (a person who arranges aspects of the surgery, such as transportation of the donor heart)
• Social worker
• Dietitian
• Psychiatrist

In general, patients selected for heart transplants have severe end-stage heart failure, but are healthy enough to have the transplant. Heart failure is considered “end stage” when all possible treatments—such as medicines, implanted devices, and surgery—have failed.

Certain conditions and factors make it less likely that a heart transplant will work well. Examples include:

• Advanced age. There is no widely accepted upper age limit for a heart transplant. However, most transplant surgeries are done on patients younger than 70 years old.
• Poor blood circulation throughout the body, including the brain.
• Kidney, lung, or liver diseases that can't be reversed.
• A history of cancer or malignant tumors.
• Inability or unwillingness to follow a lifelong care plan after a transplant.
• Pulmonary hypertension (high blood pressure in the lungs) that can't be reversed.
• Active infection throughout the body.
• Diabetes with end organ damage (damage of major organs).

Patients who have one or more of the above conditions might not be eligible for heart transplant surgery.

The Heart Transplant Waiting List

Patients who are eligible for a heart transplant are added to a waiting list for a donor heart. This waiting list is part of a national allocation system for donor organs. The Organ Procurement and Transplantation Network (OPTN) runs this system.

OPTN has policies in place to make sure donor hearts are given out fairly. These policies are based on urgency of need, available organs, and the location of the patient who is receiving the heart (the recipient).

Organs are matched for blood type and size of donor and recipient.

The Donor Heart

Guidelines for how a donor heart is selected require that the donor meet the legal requirement for brain death and that the correct consent forms are signed.

Guidelines suggest that the donor should be younger than 65 years old, have little or no history of heart disease or trauma to the chest, and not be exposed to hepatitis or HIV.

The guidelines recommend that the donor heart should not be without blood circulation for more than 4 hours.

Waiting Times

About 3,000 people in the United States are on the waiting list for a heart transplant on any given day. About 2,000 donor hearts are available each year. Wait times vary from days to several months and will depend on a recipient's blood type and condition.

A person might be taken off the list for some time if he or she has a serious medical event, such as a stroke, infection, or kidney failure.

Time spent on the waiting list plays a part in who receives a donor heart. For example, if two patients have equal need, the one who has been waiting longer will likely get the first available donor heart.

Ongoing Medical Treatment

Patients on the waiting list for a donor heart get ongoing treatment for heart failure and other medical conditions.

For example, doctors may treat them for arrhythmias (irregular heartbeats). Arrhythmias can cause sudden cardiac arrest in people who have heart failure.

The doctors at the transplant centers may place implantable cardioverter defibrillators (ICDs) in patients before surgery. ICDs are small devices that are placed in the chest or abdomen. They help control life-threatening arrhythmias.

Another possible treatment for waiting list patients is a ventricular assist device(VAD). A VAD is a mechanical pump that helps support heart function and blood flow.

Routine outpatient care for waiting list patients may include frequent exercise testing, testing the strength of the heartbeat, and right cardiac catheterization (a test to measure blood pressure in the right side of the heart).

You also might start a cardiac rehabilitation (rehab) program. Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.

The program can help improve your physical condition before the transplant. Also, you will learn the types of exercises used in the program, which will help you take part in cardiac rehab after the transplant.

Contact With the Transplant Center During the Wait

Patients on the waiting list often are in close contact with their transplant centers. Most donor hearts must be transplanted within 4 hours after removal from the donor.

At some heart transplant centers, patients get a pager so the center can contact them at any time. They're asked to tell the transplant center staff if they're going out of town. Patients often need to be prepared to arrive at the hospital within 2 hours of being notified about a donor heart.

Not all patients who are called to the hospital will get a heart transplant. Sometimes, at the last minute, doctors find that a donor heart isn't suitable for a patient. Other times, patients from the waiting list are called to come in as possible backups, in case something happens with the selected recipient.