Heart transplant

A heart transplant is an operation in which a failing heart is replaced with a healthier heart from a donor. This treatment is usually reserved for people whose condition hasn't improved enough with medicines or other surgeries.

While a heart transplant is a major operation, your chance of survival is good with proper follow-up care.

Heart transplants are performed when other treatments for heart conditions haven't worked, leading to heart failure. In adults, heart failure can be caused by

• A weakening of the heart muscle, known as cardiomyopathy.
• Coronary artery disease.
• Heart valve disease.
• A heart condition you're born with, called a congenital heart defect.
• Dangerous recurring irregular heart rhythms, called ventricular arrhythmias, that are not controlled by other treatments.
• Failure of a previous heart transplant.

In children, heart failure is most often caused by either a congenital heart condition or cardiomyopathy.

Another organ transplant may be performed at the same time as a heart transplant. This is called a multiorgan transplant. It is available for people with certain conditions at select medical centers. 

Multiorgan transplants include:

• Heart-kidney transplant. This procedure may be an option for some people who have both kidney failure and heart failure.
• Heart-liver transplant. This procedure may be an option for people with certain liver and heart conditions.
• Heart-lung transplant. Rarely, healthcare professionals may suggest this procedure for some people with severe lung and heart diseases when a heart transplant or lung transplant alone will not work.

A heart transplant is not right for everyone, however. You might not be a good candidate for a heart transplant if you:

• Are at an advanced age that would affect your ability to recover from transplant surgery.
• Have another medical condition, such as a serious kidney, liver or lung disease, that could shorten your life, even with a donor heart.
• Have an active infection.
• Have a recent personal medical history of cancer.
• Are unwilling or unable to make lifestyle changes needed to keep your donor heart healthy, such as not using recreational drugs, not smoking and limiting alcohol use.

Ventricular assist devices

For people who cannot have a heart transplant, another option may be a ventricular assist device (VAD). This is a mechanical pump that is placed in your chest. It helps pump blood from the lower chambers of your heart, called ventricles, to the rest of your body.

VADs are often used as temporary treatments for people waiting for heart transplants. These devices also are becoming more common as a long-term treatment for people who have heart failure but cannot get a heart transplant. If a VAD doesn't help your heart, healthcare professionals may sometimes consider a total artificial heart. This device takes the place of your heart's ventricles and can serve as a short-term treatment while you're waiting for a heart transplant.

Open-heart surgery comes with risks, which include bleeding, infection and blood clots. A heart transplant also has specific risks, including:

• Rejection of the donor heart. One of the most worrying risks after a heart transplant is having your body reject the donor heart.

  Your immune system may see your donor heart as something that doesn't belong, and it may try to reject it. This can damage the heart. Every heart transplant recipient receives medicines called immunosuppressants to prevent rejection. These medicines have helped lower the rate of organ rejection. If rejection does start to happen, a change in medicines will sometimes stop it.

  To help prevent rejection, it's critical that you always take your medicines as prescribed and keep all your appointments with your healthcare team.

  Rejection often occurs without symptoms. To check if your body is rejecting the new heart, you'll have frequent heart biopsies during the first year after your transplant. After that, you won't need biopsies as often.

• Primary graft failure. With this condition, which is the most frequent cause of death in the first few months after transplant, the donor heart doesn't function properly.

• Thickening or hardening of the arteries. After your transplant, it's possible that the walls of the arteries in your heart could thicken and harden. This condition is known as cardiac allograft vasculopathy. It can make blood circulation through your heart difficult and can cause a heart attack, heart failure, heart arrhythmia or sudden cardiac arrest.
• Medicine side effects. The immunosuppressants you'll need to take for the rest of your life to prevent organ rejection can cause serious kidney damage and other problems.
• Cancer. Immunosuppressants also can increase your risk of developing cancer. Taking these medicines can put you at a greater risk of skin cancer and non-Hodgkin lymphoma, among others
• Infection. Immunosuppressants make it harder for your body to fight infections. Many people who have heart transplants have an infection within the first year that requires them to be admitted to the hospital.

Preparations for a heart transplant often begin weeks or months before you receive a donor heart.

Taking the first steps

If your healthcare team recommends a heart transplant, you'll likely be referred to a heart transplant center for evaluation. Or you can select a transplant center on your own. Check your health insurance to see which transplant centers are covered under your plan.

When choosing a heart transplant center, look at how many heart transplants a center performs each year and the survival rates. You can compare transplant center statistics using a database maintained by the Scientific Registry of Transplant Recipients.

You also should check to see if a transplant center offers other services you might need. These include support groups, travel arrangements, local housing during your recovery or referrals to organizations that can help with these concerns..

Once you decide on a center, the next step is an evaluation to see if you're eligible for a transplant.

The evaluation will check to see if you:

• Have a heart condition that would benefit from transplantation.
• Might benefit from other, more conservative treatments.
• Are healthy enough for surgery and post-transplant treatments.
• Are willing to quit smoking, if you smoke, and avoid using alcohol and recreational drugs.
• Are willing and able to follow the medical program outlined by the transplant team.
• Can emotionally handle the wait for a donor heart.
• Have family or friends who can support you during this stressful time.

Waiting for a donor organ

If the transplant center medical team finds that you're a good candidate for a heart transplant, the center will put you on a waiting list. The wait can be long since there are more people who need hearts than donors. Finding a donor depends on your body size, your blood type and how sick you are.

While you're on the waiting list, your medical team monitors your heart and other organs. The team will adjust your treatment if needed. The team also helps you learn to care for your heart by eating well and being active.

If medical treatment isn't enough to support your vital organs as you wait for a donor heart, your healthcare team might suggest that you get a ventricular assist device implanted. This device helps support your heart while you wait for a donor organ. These devices are sometimes called bridges to transplantation because they give people more time until a donor heart becomes available.

Immediately before your transplant surgery

A heart transplant usually needs to take place within four hours of organ removal for the donor organ to be usable. As a result, hearts are offered first to transplant centers near the donor hospital. That is followed by centers within a certain distance.

The transplant center can give you a pager or cellphone to notify you when a potential heart becomes available. It is important to keep your cellphone or pager charged and turned on at all times.

Once you're notified, you and your transplant team need to move quickly to accept the donation. You'll need to go to the transplant hospital right away.

As much as possible, plan your travel 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. Pack an extra 24-hour supply of your medicines.

Once you arrive at the hospital, your healthcare team does a final evaluation to be sure the donor heart is suitable for you and you're ready for surgery. If your care team decides that either the donor heart or the surgery isn't right for you, you might not be able to have the transplant.

During the procedure

Mayo Clinic cardiac surgeons work with a team to perform heart transplant surgery.

Heart transplant surgery is an open-heart procedure that takes several hours. Transplant surgery is more complex and may take longer than other heart surgeries.

Before the procedure, you'll receive a medicine that causes you to enter a sleeplike state. This is called a general anesthetic. A heart-lung bypass machine keeps oxygen-rich blood flowing throughout your body during the operation.

Your surgeon will make an incision in your chest, separate your chest bone and open your rib cage to reach your heart.

Your surgeon will remove the diseased heart and sew the donor heart into place. The major blood vessels will then be connected 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 medicine to help manage pain after the surgery. A ventilator will help you breathe, and tubes in your chest drain fluids from around your lungs and heart. After surgery, you'll receive fluids and medicine through a vein.

After the procedure

You'll stay in the intensive care unit (ICU) for a few days after your transplant. After that, you will be moved to a regular hospital room. You're likely to stay in the hospital for a week or two. The amount of time spent in the ICU and in the hospital varies from person to person.

After you leave the hospital, your transplant team monitors you closely. You'll need frequent checkups at first. Many people stay near the transplant center for the first three months. Afterward, the follow-up visits become less frequent, and travel is easier.

You'll be monitored for any signs or symptoms of rejection. These can include 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 a heart transplant, you have regular heart biopsies to determine whether your body is rejecting the new heart. These happen often during the first few months after transplant, when rejection is most likely to occur. As time goes on, you will need fewer biopsies.

During a heart biopsy, a healthcare professional inserts a tube into a vein in your neck or groin and guides it to your heart. A biopsy device is then guided 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 changes after you have had your heart transplant. These include:

• Taking immunosuppressants. These medicines lower the activity of your immune system to prevent it from attacking your donated heart. You'll take some of these antirejection medicines for the rest of your life.

Because immunosuppressants make your body more vulnerable to infection, your care team also might prescribe antibacterial, antiviral and antifungal medicines. Some medicines could worsen or raise your risk of developing conditions such as high blood pressure, high cholesterol, cancer or diabetes.

Over time, as the risk of rejection gets lower, the doses and number of antirejection medicines can be reduced.

• Managing medicines and a lifelong care plan. After a heart transplant, taking all your medicines as your healthcare professional instructs and following a lifelong care plan are vital.

  A daily routine for taking your medicines may be helpful. Keep a list of all your medicines with you at all times for medical appointments and in case you need emergency care. Check with your healthcare professional before you use any medicines, including those you can buy without a prescription, as well as vitamins, supplements or herbal products.

  Your healthcare professional might give you advice about your lifestyle. Recommendations may include wearing sunscreen, exercising, eating a healthy diet and being careful to lower your risk of infection. Your healthcare team also may recommend that you avoid tobacco products or recreational drugs and limit alcohol use.

  Follow your healthcare team's instructions, attend regular follow-up appointments, and let your healthcare professional know if you have signs or symptoms of complications.

• Cardiac rehabilitation. This program includes exercise and education to help you improve your health and recover after a heart transplant. Cardiac rehabilitation can help you regain your strength and improve your quality of life. You may start it before you leave the hospital.

Most people who get a heart transplant enjoy a good quality of life. Depending on your condition, you may be able to resume many of your daily activities, such as work, hobbies, sports and exercising. Talk to your healthcare professional about what activities are suitable for you.

Some people who have had heart transplants can become pregnant. If you're thinking about having children after your transplant, talk to your healthcare professional. You'll likely need to adjust your medicines before becoming pregnant. Some medicines can cause pregnancy complications.

Survival rates after heart transplantation vary based on a number of factors. These rates continue to improve despite an increase in older and higher-risk heart transplant recipients. Worldwide, the overall survival rate is about 80% after one year and about 70% after five years for adults.

What if your new heart fails?

Heart transplants aren't successful for everyone. Your new heart can fail for a number of reasons. If this happens, your healthcare professional might suggest adjusting your medicines. In more extreme cases, your care team may recommend another heart transplant.

If there aren't many treatment options left, you might choose to stop treatment. Talk with your heart transplant team, healthcare professional and family about what you expect and prefer for treatment, emergency care and end-of-life care.