A heart transplant replaces your injured or diseased heart with a healthy donor heart. It is a major medical procedure.
Transplants are usually reserved for those with life-threatening heart conditions that can’t be helped by medications or other treatments. Doctors sometimes refer to this as “end stage” treatment.
Thanks to substantial advances in medical technology, the survival rate after a heart transplant is typically good. According to the National Heart, Lung, and Blood Institute, about 88 percent of patients survive the first year after transplant surgery. About 75 percent survive for five years after the surgery, and about 56 percent survive for more than 10 years (NHLBI).
The most common reason adults receive a heart transplant is that both ventricles of the heart—the lowest chambers that pump blood—aren’t functioning properly.
Childhood heart transplants are usually performed to correct deformities that have been present since birth.
Other reasons for a heart transplant include:
- coronary heart disease
- viral infections of the heart
- damaged heart valves
- damaged heart muscle
- multiple heart failures
- failure of a previous heart transplant
However, there are a limited number of hearts available. Not everyone who needs a heart is a candidate for transplant. Certain factors can disqualify you, such as:
- being over the age of 65
- diabetes with end organ damage
- extensive peripheral artery disease, or blockages in the arteries in your arms and legs
- irreversible pulmonary hypertension
- irreversible kidney, lung, or liver diseases
- refusal to make lifestyle changes, such as abstaining from alcohol and smoking
- having another condition that could shorten your life
Heart transplants carry many risks. However, if your heart is failing, it is considered a life-saving measure.
The major risk is rejection of the donor heart. Rejection occurs when your immune system attacks the donor heart as if it were an infection. Your doctor will give you medication to suppress your immune system. However, nearly 25 percent of heart transplant recipients will experience some sign of rejection in the first year, according to the Mayo Clinic (Mayo Clinic).
Other risks of heart transplant surgery include:
- cancer and malignancies due to immunosuppressant medications
- increased risk of infection
- hardening and thickening of the arteries
- high blood pressure
- side effects from medication
It is very important to follow your doctor’s instructions for before and after your surgery. This can help decrease your risks. You will need to make healthy lifestyle choices, such as:
- not smoking
- avoiding alcohol
- adopting a heart-friendly diet
- never missing a dose of medication
Transplant preparation typically begins months in advance.
Once your doctor determines a transplant is needed, you’ll be referred to a heart transplant center. There, your transplant eligibility will be evaluated.
Consider the following when choosing a transplant center (Mayo Clinic):
- if they are covered by your insurance plan
- the number of transplants done there in a year
- their transplant recipient survival rate
- availability of other services, such as support groups and assistance with travel and housing arrangements
Once you’ve selected your transplant center and have been approved for donation, the wait for a donor heart begins. This can be an emotionally troubling time. Patients waiting for a donor heart are ranked by need and necessity. It can be stressful to see your number move up and down and know it affects your chance for a heart.
For example, for the first three months of 2012, there were 3,206 active people awaiting a heart transplant. Only 616 hearts were donated in that time, according to data from the Organ Procurement and Transplantation Network (OPTN).
While you are on the transplant list, you will be given a special pager or similar device. It will alert you when a matching donor heart becomes available.
When you arrive at the hospital for your transplant, you’ll be prepped for surgery. This includes changing into a hospital gown and other procedures. You’ll be given an IV where doctors can give you medications and fluids.
During your transplant, you’ll be in a deep, painless sleep under general anesthesia. Heart transplants typically take four hours. (NHLBI)
In the operating room, your surgeon will make a large incision in your chest over your heart. Your ribcage will be separated. This gives your doctor access to your heart.
Your surgeon will hook you up to a heart-lung bypass machine. This does the work of the heart and lungs. It allows your diseased heart to be removed and the donor heart to be put in place. You will be kept on bypass until the donor heart is ready to function.
After you are put on bypass, your heart will be cut out at the main veins and arteries. Your heart will be removed. The donor heart will be put in place and stitched to the coronary arteries and veins.
Your new heart will usually begin beating when your surgical team turns off the heart-lung machine and blood begins flowing through it. If it doesn’t, a small electrical shock will be used to start the heart.
When your surgeon is satisfied with how your new heart is working, he or she will put everything back in its place. Your incision wound will be closed with stitches, and you’ll be moved to an intensive care unit. There your vital signs will be closely monitored. Attending nurses will wait for you to awake.
You can expect to spend a day or two in the intensive care unit. Your whole hospital stay will probably last one to two weeks. Once home, you’ll be closely monitored on an outpatient basis at your transplant center for about three months. (Mayo)
During the days and months after your surgery, you’ll regularly undergo imaging and blood tests to ensure your new heart is functioning properly and check for rejection. To reduce rejection risk, you’ll be given immunosuppressants. These drugs suppress your immune system, so that it doesn’t attack your new heart.
If your body rejects your heart, that is a serious medical emergency. Contact your doctor immediately. If your symptoms are severe, call 911. Signs that your body may be rejecting your donor heart include:
- gaining weight because of water retention
- less frequent urination
- shortness of breath
Rehabilitation after a heart transplant is a lengthy process. It involves:
- eating right
- being strict with your medication regimen
- following your doctor’s instructions exactly as they are given to you
It is important to learn as much as you can about protecting your heart before and after a transplant. Your doctor, surgeon, and transplant team will provide you with comprehensive information about aftercare. Do not feel shy about asking any questions.