What is a Heart Transplant?
A heart transplant replaces a failing heart with a donor's healthy heart. A heart transplant is a major surgery done when other treatments and interventions aren’t enough. Though the surgery carries risk, most people who receive a heart transplant have a positive outcome.
Reasons for performing a heart transplant operation may include:
- Heart failure – Also called congestive heart failure, this occurs when the heart cannot pump blood properly. Different conditions may cause the main ventricles (lower heart chambers) to become weak, damaged, or stiff, meaning the heart is unable to fill or pump blood to the body.
- Cardiomyopathy – A disease of the heart muscle that makes pumping blood to the rest of the body difficult
- Heart valve disease – Can be caused by congenital heart defects, infection, or other heart conditions
- Coronary artery disease - Heart disease caused by a buildup of fatty deposits in the arteries, which reduces blood flow
- Congenital heart defects (present at birth) – Defects in a heart chamber or heart valve can weaken the heart by making it work harder than normal to pump blood
- Complications from congenital heart defects - Complications that may develop later in life
- Ventricular arrhythmias - Recurring irregular heart rhythms that do not respond to other treatments
- Failure of a previous heart transplant
Assessing Transplant Eligibility
Heart transplants may be recommended for people with serious heart conditions that cause heart failure when other treatment options don't work. The process for evaluating a patient's eligibility for a heart transplant will help decide if:
- The heart transplant procedure is safe for the patient
- Heart transplantation will improve the patient's condition
- There are other suitable treatment options
- The patient is willing to go through the surgery and recovery treatment
- The patient is willing and able to follow the recommended medical plan and make necessary lifestyle changes, such as quitting smoking
Some patients with heart failure may not be good candidates for a heart transplant because of:
- Age – Some older adults may not be able to recover from transplant surgery
- Other medical conditions - Patients with serious conditions including kidney, liver, or lung disease
- Cancer - Those who have cancer or had cancer recently
- Lifestyle - Patients may have to make lifestyle changes to keep a donated heart healthy. People who smoke, drink alcohol in excess, or use drugs for recreation and are not willing or able to quit may not be good candidates for a heart transplant.
Waiting for a Donor
Each NewYork-Presbyterian patient awaiting an organ transplant is added to the national computerized waiting list that the United Network maintains for Organ Sharing (UNOS). This registry contains detailed information about each patient, including blood type, the level of medical urgency, body size, and other data that is needed to match donors to recipients. Waiting for a heart donation can be long and difficult emotionally, but our care team at NewYork-Presbyterian is here to support patients every step of the way.
While waiting for a matching heart donation, patients are monitored by the medical team, and treatment continues and is adjusted as needed. Doctors may recommend implanting a ventricular assist device (VAD) to support the patient's heart.
When the UNOS system receives information about available organ donations, it identifies candidates who may be a match for a donor's organs. Next, each available organ is allocated according to medical urgency, degree of match to the donor, and time waiting. When information about a potential organ that may match a NewYork-Presbyterian transplant candidate is received at a NewYork-Presbyterian hospital, the patient is notified and has a limited time to accept the donation and go to the transplant hospital.
The doctors will conduct a final check of the donation and patient. The transplant surgeon makes the final decision about whether or not the donor and intended recipient are a good match.
Information about NewYork-Presbyterian's process for bringing organs from donors to recipients, including details about heart donations are described here.
Preparing for Heart Transplant Surgery
The hospital where the surgery takes place will ask patients on the heart transplant waiting list to be ready to arrive at the hospital within four hours. When a donor heart is available, the hospital's transplant coordinator will call the patient with specific instructions and ask them to come to the hospital immediately.
When arriving at the hospital, the heart transplant team will prepare the patient for heart transplant surgery. Preparation may include:
- Physical examination
- Blood work
At the operating room, the patient receives general anesthesia and sleeps through the heart transplant procedure.
How is a Heart Transplant Surgery Performed?
During the heart transplant surgery, the surgeon and care team will:
- Connect the patient to a heart-lung machine that pumps filtered, oxygen-rich blood to the patient's body
- Remove the diseased heart
- Replace it with the healthy donor heart
The time a heart transplant surgery takes depends on the case and if other procedures are performed.
- The surgery takes about three to four hours
- If the patient has a VAD (ventricular assist device) that should be removed, the surgery may take six to eight hours
If multi-organ transplant surgery is performed, the surgery is more complex and will take longer. Multi-organ transplant surgeries (including heart-lung, heart-liver, and heart-kidney transplant) are performed to replace more than one organ with healthy organs, usually from the same donor.
Risks to Consider
Risks of heart transplant include:
- Bleeding during and after the surgery
- Blood clots – Can cause stroke, heart attack, or lung issues
- Breathing problems
- Rejection - Rejection of the donor's heart by the patient's immune system. Immunosuppressant medications are given to lower the risk of rejection from the patient's immune system.
- Failure of the donor heart (primary graft failure) - When the transplanted heart doesn't work properly and can cause death
- Artery condition (coronary allograft vasculopathy, CAV) - The blood vessels to the heart muscle may become thick and hard. This can cause serious heart muscle damage and related heart attack conditions, heart failure, heart arrhythmias, or sudden cardiac death.
- Infection - Immunosuppressants decrease your ability to fight infection. Many people who have heart transplants have an infection that requires them to be admitted to the hospital in the first year after their transplant.
- Kidney damage - Can occur as a side effect of the immunosuppressant medication that patients are required to take as part of their treatment
- Cancer - Immunosuppressants can increase the risk of developing skin cancer, non-Hodgkin's lymphoma, and other types of cancer
What to Expect after Heart Transplant
After heart transplant surgery, you’ll stay in the intensive care unit (ICU) for a few days where your condition will be monitored closely. When you’re ready, you’ll move to a regular hospital room for a week or two, depending on their situation. Patients receive pain medicine as needed and start eating and drinking once their bowels are functioning normally.
Your heart transplant team will provide specific instructions before you leave the hospital. Typically, patients have frequent follow-up visits for a few months so their transplant team can continue monitoring their progress. You should pay attention to and let the heart transplant team know of symptoms of rejection or infection, including fever, fatigue, shortness of breath, or weight gain.
Treatment at home includes:
- Taking medications
- Immunosuppressant medications to prevent or decrease the immune system response to the transplanted heart
- Antibacterial, antiviral, and antifungal medications to prevent infection
- Cardiac rehabilitation includes exercise and education plans to help patients recover after a heart transplant. Cardiac rehabilitation helps patients increase their strength.
Receive a Heart Transplant at NewYork-Presbyterian
NewYork-Presbyterian's heart transplantation team is experienced and world-renowned in regard to heart failure care, including for high-risk and multi-organ transplant patients. Learn more about other organ transplantation programs we offer, and contact us to schedule a heart transplant consultation today.