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 sufficiently improved.
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.
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 several conditions, including:
- A weakening of the heart muscle (cardiomyopathy)
- Coronary artery disease
- Heart valve disease
- A heart problem you're born with (congenital heart defect)
- Dangerous recurring abnormal heart rhythms (ventricular arrhythmias) not controlled by other treatments
- Failure of a previous heart transplant
In children, heart failure is most often caused by either a congenital heart defect or a cardiomyopathy.
Another organ transplant may be performed at the same time as a heart transplant (multiorgan transplant) in people with certain conditions at select medical centers.
Multiorgan transplants include:
- Heart-kidney transplant. This procedure may be an option for some people with kidney failure in addition to heart failure.
- Heart-liver transplant. This procedure may be an option for people with certain liver and heart conditions.
- Heart-lung transplant. Rarely, doctors may suggest this procedure for some people with severe lung and heart diseases, if the conditions aren't able to be treated by only a heart transplant or lung transplant.
Factors that may affect your eligibility for a heart transplant
A heart transplant isn't the right treatment for everyone. Certain factors may mean you're not a good candidate for a heart transplant. While each case is considered individually by a transplant center, a heart transplant may not be appropriate if you:
- Are an advanced age that would interfere with the ability to recover from transplant surgery
- Have another medical condition that could shorten your life, regardless of receiving a donor heart, such as a serious kidney, liver or lung disease
- Have an active infection
- Have a recent personal medical history of cancer
- Are unwilling or unable to make lifestyle changes necessary to keep your donor heart healthy, such as not drinking alcohol or not smoking
Ventricular assist devices
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 mechanical pump implanted in your chest that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body.
VADs are commonly used as a temporary treatment for people waiting for a heart transplant. These devices are increasingly being used as a long-term treatment for people who have heart failure but aren't eligible for a heart transplant. If a VAD doesn't help your heart, doctors may sometimes consider a total artificial heart — a device that replaces the ventricles of your heart — as an alternative short-term treatment while you're waiting for a heart transplant.
Complications of surgery
Heart transplant surgery requires open heart surgery, which carries the risk of many complications, including:
- Blood clots
- Heart attack
Risks of having a heart transplant
Although receiving a donor heart can save your life, having a heart transplant has many risks. Risks include:
Rejection of the donor heart. One of the most significant risks after a heart transplant is your body rejecting the donor heart.
Your immune system will see your donor heart as a foreign object that's not supposed to be in your body. Your immune system will try to attack your donor heart. Although all people who receive a heart transplant receive immunosuppressants — medications that reduce the activity of the immune system — about 10 percent of heart transplant recipients still have some signs of rejection that need treatment during the first year after transplantation. This is often effectively treated with medication.
Usually the rejection is without any symptoms and requires only an adjustment of medications. If you miss doses of medications, however, the rejection can be severe and very serious. It's important that you follow the instructions as explained by your doctors.
To determine whether your body is rejecting the new heart, you'll have frequent heart biopsies to test your heart tissue during the first year after your transplant. After the first year, the number of biopsies is significantly reduced.
Problems with your coronary arteries. After your transplant, it's possible the walls of the arteries in your heart (coronary arteries) could thicken and harden, leading to cardiac allograft vasculopathy (CAV). This can make blood circulation through your heart difficult and can cause a heart attack, heart failure, abnormal heart rhythms (arrhythmias) or sudden cardiac death.
Your doctor may recommend annual tests after your transplant to monitor your coronary arteries for CAV.
- Medication side effects. The immunosuppressants you'll need to take for the rest of your life may cause kidney damage and other problems. Other complications of these medications can include high blood pressure, high cholesterol, diabetes and a condition in which your bones become thin and weak (osteoporosis).
- Cancer. Immunosuppressants can also increase your cancer risk. Taking these medications can put you at a greater risk of skin cancer, non-Hodgkin's lymphoma and other solid tumors. Regular checkups are necessary to detect the development of cancer.
- Infection. Immunosuppressants decrease your ability to fight infection. Some heart transplant recipients may develop an infection that requires them to be admitted to the hospital during the first year after their transplant. The risk of infection decreases over time as the amount of immunosuppressant medication is decreased.
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, months or years before you receive a donor heart, depending upon the waiting time for transplant.
Taking the first steps
If your doctor recommends that you consider a heart transplant, you'll likely be referred to a heart transplant center for an evaluation. You're also free to select a transplant center on your own. Check with your health insurance provider to see which transplant centers are covered under your insurance plan.
When evaluating a heart transplant center, 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 using a database maintained by the Scientific Registry of Transplant Recipients.
Also consider additional services that may be provided by a transplant center. Many centers may coordinate support groups, assist 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. During an evaluation, your doctors and transplant team will conduct a physical examination, order several tests, and evaluate your mental and emotional health. The evaluation will check to see if you:
- Have a heart condition that would benefit from transplantation
- Might benefit from other less aggressive treatment options
- Are healthy enough to undergo surgery and post-transplant treatments
- Will agree to quit smoking, if you smoke
- Are willing and able to follow the medical program outlined by the transplant team
- Can emotionally handle the wait for a donor heart
- Have a supportive network of family and friends to help you during this stressful time
Your transplant team will also discuss with you the benefits and risks of a transplant and what to expect before, during and after a transplant.
Waiting for a donor organ
If the transplant team determines that you're a candidate for a heart transplant, the transplant center will register you on a waiting list. At any given time, there are about 3,000 people in the U.S. waiting for heart transplants. Unfortunately, there aren't enough hearts for every person in need, and some people die while waiting for a transplant.
While you're on the waiting list, your medical team will closely monitor your condition and alter your treatment as needed. 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.
Your doctors may recommend that you participate in a cardiac rehabilitation program while you wait for a donor heart. Cardiac rehabilitation is a program of exercise and education designed to help improve your health before and after your heart transplant.
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, such as a ventricular assist device (VAD). These devices are also referred to as a bridge to transplant because they stabilize your condition until a donor heart is available.
When a donor heart becomes available, the donor-recipient matching system considers several factors to make a match, including:
- Medical urgency of potential recipients
- Blood type (A, B, AB or O)
- Antibodies the recipients may have developed
- Size of the donor
- Time spent on the waiting list
Immediately before your transplant surgery
A heart transplant usually needs to occur within four hours of organ removal for the donor organ to remain usable. As a result, hearts are offered first to a transplant center close by, then to centers within certain distances of the donor hospital.
You'll need to remain in close contact with the transplant team and let them know if you have any changes to your health. Make sure the transplant center has phone numbers to be able to contact you anytime. The transplant center needs to be able to reach you 24 hours a day.
When you're notified that a potential organ is available, you and your transplant team have a limited amount of time to consider whether to accept the donation. You'll be expected to travel to the transplant hospital immediately after being notified of the potential donation. You'll usually need to be prepared to get to the hospital within three hours.
As much as possible, you should generally 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.
Once you arrive at the hospital, your doctors and transplant team will conduct a final evaluation to determine if the donor heart is suitable for you and if you're ready to have surgery. If your doctors and transplant team decide that the donor heart isn't appropriate for you or surgery isn't appropriate for you, you may not be able to have the transplant.
During the procedure
Heart transplant surgery is an open heart surgery that takes several hours. If you've had previous heart surgeries, the surgery is more complicated and will take longer. You'll receive medication that causes you to sleep (general anesthesia) before the procedure. Your surgeons will connect you to a heart-lung bypass machine to keep oxygen-rich blood flowing throughout your body.
In this procedure, your surgeon will make an incision in your chest. Your surgeon will separate your chest bone and open your rib cage so that he or she can operate on your heart.
Your surgeon then removes the diseased heart and sews the donor heart into place. He or she then attaches the major blood vessels to the donor heart. The new heart often starts beating when blood flow is restored. Sometimes an electric shock is needed to make the donor heart beat properly.
You'll be given medication to help with pain after the surgery. 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 surgery, you'll also receive fluids and medications through intravenous (IV) tubes.
After the procedure
After you've had surgery to place your donor heart, you'll stay in the intensive care unit (ICU). You'll generally be moved to a regular hospital room after a few days in the ICU, and you'll usually remain in the hospital for a week or two. The amount of time you'll spend in the ICU and in the hospital can vary.
After you leave the hospital, you'll be closely monitored at your outpatient transplant center by your transplant team. Due to the frequency and intensity of the monitoring, many people stay close by the transplant center for the first three months. Afterward, the follow-up visits are less frequent, and it's easier to travel back and forth for follow-up visits.
You'll also be monitored for any signs or symptoms of rejection, such as shortness of breath, fever, fatigue, not urinating as much or weight gain. It's important to let your transplant team know if you notice any signs or symptoms of rejection or infection.
After your heart transplant, you'll have several follow-up appointments at the transplant center. You'll have regular tests, including blood work, echocardiograms, electrocardiograms and heart biopsies.
To determine whether your body is rejecting the new heart, you'll have frequent heart biopsies in the first few months after heart transplantation, when rejection is most likely to occur. The frequency of necessary biopsies decreases over time.
During a heart biopsy, a doctor inserts a tube into a vein in your neck or groin and directs it to your heart. A doctor runs a biopsy device through the tube to remove a tiny sample of heart tissue, which is examined in a lab.
You'll need to make several long-term adjustments after you've had your heart transplant. These include:
Taking immunosuppressants. These medications decrease the activity of your immune system to prevent it from attacking your donated heart. Because your immune system will most likely never completely accept the new organ, you'll take some of these medications for the rest of your life.
Immunosuppressant medications may cause noticeable side effects. For example, when taking post-transplant drugs such as corticosteroids, your face may become round and full, and you may gain weight, develop acne or facial hair, or experience stomach problems. Some side effects of immunosuppressant drugs may be more noticeable when you first start the drugs, but they may decrease in severity over time.
Because immunosuppressants make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications.
Some immunosuppressants could also worsen conditions — or raise your risk of developing conditions — such as high blood pressure, high cholesterol, cancer, osteoporosis or diabetes.
Over time as the risk of rejection is reduced, the doses and number of anti-rejection drugs can be reduced, but you'll need some immunosuppressant medications indefinitely.
Managing medications, therapies and a lifelong care plan. After a heart transplant, taking all your medications as your doctor instructs and following a lifelong care plan is important.
Your doctor may give you specific instructions regarding lifestyle guidelines, such as wearing sunscreen, not using tobacco products, exercising, eating a healthy diet and being careful to lower your risk of infection in daily life.
Follow all of your doctor's instructions, see your doctor regularly for follow-up appointments, and let your doctor know if you have any signs or symptoms of complications.
It's a good idea to set up a daily routine for taking your medications so that you won't forget. Keep a list of all your medications with you at all times in case you need emergency medical attention, and tell all your doctors what you take each time you're prescribed a new medicine.
Cardiac rehabilitation. Cardiac rehabilitation programs incorporate exercise and education to help you improve your health and recover after a heart transplant. Staff members trained in cardiac rehabilitation may help you adjust to healthy lifestyle changes — such as regular exercise and a heart-healthy diet — after your transplant.
Your transplant team may also suggest that you begin a cardiac rehabilitation program prior to your transplant to improve your health.
Emotional support. Your new medical therapies and the stress of having a heart transplant may make you feel overwhelmed. Many people who have had a heart transplant feel this way.
Talk to your doctor if you're feeling stressed or overwhelmed. Transplant centers often have support groups and other resources to help you manage your condition.
Most people who receive a heart transplant enjoy a high quality of life. Depending on your condition, you may be able to return to many of your daily life activities, such as returning to work, participating in hobbies and sports, and exercise. Discuss with your doctor what activities are appropriate for you.
Some women who have had a heart transplant can become pregnant. However, discuss with your doctor if you're considering having children after your transplant. You'll likely need medication adjustments before becoming pregnant, as some medications can cause pregnancy complications.
Heart transplant recipient survival rates vary based on a number of factors. A 2014 report by the Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients stated that the overall survival rate in the U.S. is about 88 percent after one year and about 75 percent after five years.
What if your new heart fails?
Heart transplants aren't successful for everyone. Your new heart may fail because of organ rejection or because of the development of heart valve disease or coronary artery disease. Should this happen, your doctor may recommend adjusting your medications or in more serious cases, another heart transplant.
In some cases, additional treatment options are limited, and you may choose to stop treatment. Discussions with your heart transplant team, doctor and family should generally address your expectations and preferences for treatment, emergency care and end-of-life care.