A heart transplant is a surgical procedure used to treat the most serious cases of heart disease. This is a treatment option for patients who are in the end stages of heart failure, for whom medication, lifestyle changes, and less invasive procedures haven't succeeded. Those waiting for a heart transplant must fit very specific criteria to be considered a candidate for the procedure.
Candidacy for Heart Transplants
Heart transplant candidates are those who have experienced heart disease or heart failure due to a variety of causes, including:
- congenital defects
- coronary artery disease
- valve dysfunction or disease
- weakened heart muscle (cardiomyopathy)
Even if you suffer from one of these ailments, there are still more factors that come into play when determining your candidacy, such as:
- age: most prospective heart recipients must be under 65 years old
- overall health: multiple organ failure, cancer, or other serious medical conditions may take you off a transplant list
- attitude: you must commit to changing your lifestyle. For example: quit smoking, exercise, and eat healthily
If you're determined an ideal candidate for a heart transplant, you'll be put on a waiting list until a donor heart that matches your blood and tissue type is available.
Sadly, not everyone on the waiting list will survive until a heart is found. An estimated 2,000 donor hearts become available in the United States each year. Yet, at any given time, approximately 3,000 individuals are on a heart transplant waiting list, according to the University of Michigan. When a heart is found for you, surgery is performed as soon as possible while the organ is still viable—usually within four hours.
Heart transplant surgery lasts for approximately four hours. During that time, you'll be placed on a heart-lung machine to keep blood circulating throughout your body. The surgeon will remove your heart, leaving the pulmonary vein openings and the back wall of the ?left atrium intact, ready to receive the new heart.
Once the donor heart is stitched into place and begins beating, you'll be removed from the heart-lung machine. In most cases, your new heart will begin to beat as soon as blood flow is restored to it. But, sometimes an electric shock is required to prompt a heartbeat.
The next stop after surgery is the intensive care unit (ICU). You'll be monitored constantly, given pain medication, and outfitted with drainage tubes to remove excess fluid from your chest cavity.
Recovery from a heart transplant can be a long process, spanning up to six month for many people. After the first day or two after the procedure, you'll most likely be moved from the ICU, but you'll remain in the hospital as you continue to heal. Hospital stays range from one to three weeks, based on your individual rate of recovery.
You'll be monitored for infection and your medication management will begin. Anti-rejection medications are crucial to ensure that your body doesn't reject your donor organ. You may be referred to a cardiac rehabilitation unit or center to help you adjust to your new life as a transplant patient.
Frequent follow-up appointments are crucial to the long-term recovery and management of a heart transplant. Your medical team will perform blood tests, heart biopsies through catheterization, and echocardiograms on a monthly basis for the first year after the operation to ensure that your new heart is functioning properly. Your immunosuppressant medications will be adjusted if needed, and you'll be asked if you've suffered from any of the possible signs of rejection, including:
- shortness of breath
- weight gain due to fluid retention
- reduced urine output
Report any changes in your health to your cardiac team so that your heart function can be monitored if required. After the first year post-transplant, your need for frequent monitoring will decline, although you'll still need yearly testing.
Women of childbearing age should consult their cardiologist before starting a family. Pregnancy is safe for most heart transplant patients, explains the University of Michigan Department of Cardiac Surgery. However, expectant mothers who have pre-existing heart disease or who have had a transplant are considered high risk and may experience a greater chance of pregnancy-related complications and a higher risk of organ rejection.
Outlook and Life Expectancy
Receiving a new heart can improve your quality of life considerably, but you have to take good care of it. In addition to taking daily anti-rejection medications, you'll need to follow a heart-healthy diet and lifestyle as prescribed by your doctor. This includes not smoking and exercising on a regular basis if you're able.
Survival rates for heart transplant patients vary according to their overall health status, but averages remain high. Rejection is the main cause for a shortened life span. Approximately 80 percent of heart transplant recipients survive the first two years post-transplant, according to the National Institutes of Health (NIH). Long-term rates are generally lower, but are still encouraging. About 70 percent of patients reach the five year mark after a heart transplant and 50 percent live for 10 years or more with a donor heart.
To learn more about heart transplants, read the story of one woman's personal experience by clicking here.