What Is a Heart Transplant?

A heart transplant is a major surgery during which a failing, diseased heart is replaced by a healthy donor heart.^1-3 A heart transplant is the only cure for end-stage heart failure and is generally the last choice of treatment, considered after medications and other cardiac procedures have failed.³ Not everyone is a candidate for a heart transplant. Because there is a limited supply of organs, there are rigorous criteria to be met before being placed on the waiting list.^1-2

Evaluation process

Having a heart transplant involves more than just surgery. Potential recipients go through an extensive evaluation process at a heart transplant center which includes a physical exam, a variety of blood and imaging tests, and a psychological assessment of mental and emotional well-being and social support.^1-3 The transplant team considers all the collected information from interviews, medical history, clinical findings, and diagnostic test results to determine eligibility for a heart transplant.^1-3

Once approved, candidates for heart transplant get registered in a database which is the United Network for Organ Sharing (UNOS) waiting list.³ Both the heart and the general medical condition of a patient may continue to decline while awaiting a transplant. Illness or deterioration in condition can result in being temporarily or permanently removed from the list.^1-2

Each candidate for a heart transplant will have a transplant team who will educate both the patient and their family, so they know what to expect throughout the heart transplant process.^1-3 This includes what is required before transplant (preoperative protocol), the risks of the surgery, and all the care that is required after transplant.¹

Transplant eligibility

A heart transplant is not appropriate for everyone who has a failing heart. There is an evaluation process that is required to determine who would be a good candidate for the surgery.^1-3

Some considerations in the evaluation process include:^1-2

• Advanced age
• Comorbidities (other illnesses or diseases) that could shorten your life
• Active infection or recent history of cancer
• Unwilling or unable to commit to lifestyle changes like no alcohol or smoking

Donor match

Matching a donor and a recipient requires medical and physiological compatibility. The process considers medical severity, matched blood type, the size of the recipient and donor and the time on the waiting list.^1-3

Complications

There are risks of having and complications that can occur after a heart transplant. The most significant complication is a rejection of the donor heart.¹ The body’s immune system considers the donor heart as foreign and will attack it. For this reason, everyone who has a heart transplant receives medications called immunosuppressants which reduce the activity of the immune system.^1-3

Another common complication is infection. The immunosuppressants decrease how the immune system responds to viruses and bacteria, which can lead to infections. In future years, patients who have had transplants are at risk for developing different kinds of cancers.³

Medications

Following a transplant, recipients will take a variety of medications to try to keep the heart healthy and the body from attacking the heart.^1-3 Even with anti-rejection medications, immunosuppressants, ten percent of heart transplant recipients will experience signs of rejection like shortness of breath, fever, fatigue, reduced urination or weight gain.^1-2 These symptoms require treatment during the first year. Medication can generally manage the symptoms of rejection.^1-3

Other medications like antibacterial, antiviral and antifungal medications may be prescribed because the body cannot protect itself as well when taking immunosuppressants. It is important to take all medications as prescribed. Missing doses can cause serious problems.²

Medical follow-up

Regular medical visits, EKGs, and heart biopsies to evaluate heart tissue and signs of rejection during the first year after transplant are part of the follow-up process. This number reduces over time.^1-2 Transplant recipients commonly take immunosuppressants for the rest of their lives. These medications can contribute to kidney damage, increased risk of infection, and other complications which may include high blood pressure, high cholesterol, diabetes and weakened bones (osteoporosis).^1-2

Cardiac rehabilitation

Cardiac rehabilitation will likely be recommended by your healthcare team. Cardiac rehab is a program of exercise and education about good health habits, designed to facilitate recovery and to teach people to live a heart-healthy life. Cardiac rehab is an individualized program designed to meet the needs and lifestyle of each person and their general health condition.¹

Most people who have undergone heart transplant and follow the medication, diet, and exercise plans laid out by their rehab plan resume a better quality of life and can return to work and routine social activities.¹