A heart transplant is an operation in which a failing, diseased heart is replaced with a healthier, donor heart. Heart transplant is a treatment that's usually reserved for people who have tried medications or other surgeries, but their conditions haven't improved sufficiently.
While a heart transplant is a major operation, your chance of survival is good, with appropriate follow-up care.
When faced with a decision about having a heart transplant, know what to expect of the heart transplant process, the surgery itself, potential risks and follow-up care.
Why it's done
Heart transplants are performed when other treatments for heart problems haven't worked, leading to heart failure. In adults, heart failure can be caused by:
In children, heart failure is most often caused by either a congenital heart defect or a cardiomyopathy.
A heart transplant isn't the right treatment for everyone, however. Certain factors may mean you're not a good candidate for a heart transplant. While each case is considered individually by a transplant center, you could be prevented from having a heart transplant if you:
For some people who can't have a heart transplant, another option may be a ventricular assist device (VAD). A ventricular assist device is a miniature pump implanted in your chest that helps pump blood through your body. VADs are commonly used as a temporary treatment for people waiting for a heart transplant, but are increasingly being used as a permanent treatment for heart failure.
Although receiving a donor heart can save your life, having a heart transplant has many risks. The most significant risk is your body rejecting the donor heart.
Rejection of the donor heart
To determine whether your body is rejecting the new heart, you'll have frequent biopsies of the new heart for several months after your transplant. During the biopsy, a tube is inserted into a vein in your neck or groin and directed to your heart. A biopsy device is run through the tube to extract a tiny sample of heart tissue, which is examined in a lab. Because rejection is most likely to occur in the first few months after heart transplantation, the frequency of heart biopsies is greatest during this early period. It's possible you'd have signs or symptoms that your body is rejecting your donor heart. These signs and symptoms could include:
How you prepare
Preparations for a heart transplant often begin long before the surgery to place a transplanted heart. You may begin preparing for a heart transplant weeks or months before you receive a donor heart.
Taking the first steps
When looking at heart transplant centers, consider the number of heart transplants a center performs each year and transplant recipient survival rates. You can compare transplant center statistics on the Web through a database maintained by the Scientific Registry of Transplant Recipients.
Also consider additional services provided by a transplant center. Many centers coordinate support groups, assist you with travel arrangements, help you find local housing for your recovery period, or direct you to organizations that can help with these concerns.
Once you decide where you would like to have your heart transplant, you'll need to have an evaluation to see if you're eligible for a transplant. The evaluation will check to see if you:
Waiting for a donor organ
While you're on the waiting list, your medical team will monitor the condition of your heart and other organs and alter your treatment as necessary. Your transplant team may temporarily remove your name from the waiting list if you develop a significant medical condition, such as a severe infection or stroke, which makes you temporarily unable to have a transplant while you recover.
If medical therapy fails to support your vital organs as you wait for a donor heart, your doctors may recommend you have a device implanted to support your heart while you wait for a donor organ. These devices are known as ventricular assist devices (VADs). The devices are also referred to as a bridge to transplantation because they gain some time until a donor heart is available.
When a donor heart becomes available, the donor-recipient matching system considers these factors to make a match:
Immediately before your transplant surgery
When you're notified, you and your transplant team have a limited amount of time to consider whether to accept the donation, and you'll be expected to make your way to the transplant hospital immediately after being notified of the potential donation.
As much as possible, you should make travel plans ahead of time. Some heart transplant centers provide private air transportation or other travel arrangements. Have a suitcase packed with everything you'll need for your hospital stay, as well as an extra 24-hour supply of your medications.
Left ventricular assist device (LVAD)
A left ventricular assist device (LVAD) is implanted under your skin. It helps pump blood from the left ventricle of your heart and on to the rest of your body. A control unit and battery pack are ...
What you can expect
During the procedure
You'll be in pain after the surgery, which will be treated with medications. You'll also have a ventilator to help you breathe and tubes in your chest to drain fluids from around your lungs and heart.
After the procedure
There are also several long-term adjustments you'll need to make after you've had your heart transplant. These include:
Most people who receive a heart transplant enjoy a high quality of life. They can return to work within three to six months of a heart transplant and have few activity restrictions.
Recipient survival rates vary based on a number of factors. For example, in the U.S. the overall survival rate is nearly 90 percent after one year and 74 percent after five years.
What if your new heart fails?
In some cases, additional treatment options are limited and you may choose to stop treatment. Discussions with your heart transplant team, physician and family should address your expectations and preferences for treatment, emergency care and end-of-life care.
Last Updated: 2010-12-10
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