Finding A Donor For Heart Transplant
Firstly, you will be put on a waiting list after you are found to be eligible for a heart transplant. At the moment, there are thousands of people waiting for heart transplants because there are not enough hearts available. When you are waiting for a healthy donor heart to be available, your condition will be monitored by doctors. Your treatment can be changed depending on your condition when you are waiting for a heart to be available for transplantation surgery.
Some people develop severe medical conditions, where they may not be eligible for heart transplant surgery anymore. In this case, your name will be removed from the list until you recover from the health problem. Depending on your recovery, you may be put back on the waiting list for a donor’s heart. When you are waiting, your doctors can recommend cardiac rehabilitation to you, which provides you with information about how to stay healthy before and after a heart transplant surgery.
When you are waiting for a donor’s heart, sometimes your condition can deteriorate. This can be because the treatment that you are undergoing is unable to support your vital organs. This can cause health complications to arise. In such a case, you might need a device such as the ventricular assist device to be implanted. This helps to keep you stable until you receive a donor heart which can be transplanted in place of your diseased heart.
Life After A Heart Transplant
You will be constantly monitored after a heart transplant. In the first few months, many tests will be conducted to ensure the new heart has been accepted by your body, and to ensure additional problems won’t crop up. You will need to ensure you are staying healthy at all times so that you can enjoy a good quality of life, after a heart transplant. Ensure you meet your doctor regularly and inform him about any problems you are experiencing.
Watching For Signs Of Rejection
Your body will regard your new heart as a foreign object. Youll need medicine to prevent your immune system from attacking the heart.
You and the transplant team will work together to protect the new heart. Youll watch for signs and symptoms that your body is rejecting the organ. These signs and symptoms include:
- Shortness of breath
- Reduced amounts of urine
You and the team also will work together to manage the transplant medicines and their side effects, prevent infections, and continue treatment of ongoing medical conditions.
Your doctors may ask you to check your temperature, blood pressure, and pulse when you go home.
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What Happens During A Heart Transplant
A heart transplant needs to be carried out as soon as possible after a donor heart becomes available.
The procedure is performed under general anaesthetic, where you’re asleep.
While it’s carried out, a heart-lung bypass machine will be used to keep your blood circulating with oxygen-rich blood.
A cut is made in the middle of the chest. Your own heart is then removed, and the donor heart is connected to the main arteries and veins. The new heart should then begin beating normally.
What To Expect During A Heart Transplant
Just before the heart transplant surgery, patients will receive general anesthesia, that is, they’re temporarily put to sleep.
A bypass machine is hooked up to the arteries and veins of the heart. The machine pumps blood through the patient’s lungs and body while the diseased heart is removed and the donor heart is sewn into place.
Figure A shows where the diseased heart is cut for removal. Figure B shows where the transplanted healthy heart is sutured to the recipient’s arteries and veins.
Heart transplant surgery usually takes about four hours. Patients often spend the first days after surgery in the intensive care unit of the hospital.
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Heart Transplants May Become More Common As People Age
Heart failure is common in older people and the leading cause of hospitalizations of those 65 years old and older. The condition develops when the heart can no longer pump enough blood with oxygen and nutrients for the body.
It is aggravated by other chronic conditions, such as diabetes, high blood pressure, and being overweight, according to the health website Ada.
However, the supply of donor’s hearts is limited and doctors are forced to choose which patients have the most potential for a good recovery and long-term survival.
According to the Mayo Clinic, patients that are 70 years old or older were only considered for heart transplant surgery in the past if they are fit enough, able to take medications that are necessary to avoid rejection of the new heart, had strong support from family and friends, do not have vices like drinking and smoking, and have no other chronic diseases or infections.
But with the growing older adult population in the United States, that seems to be changing as more older people who receive heart transplants have positive results. Not to mention improvements in patient screening and care after surgery has allowed more older patients to be eligible for heart transplant surgery.
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Prognosis After Heart Transplantation
Heart transplantation is in its third decade as a widely accepted treatment for advanced heart failure. What is its prognosis? In the early era of heart transplantation, the perceived alternative to transplantation was imminent death. In 1968, at the beginning of heart transplantation, Peter Medawar, the eminent zoologist and Nobel laureate whose work on tolerance set the scene for successful transplantation, correctly predicted: The transplantation of human organs will be assimilated into ordinary clinical practice . . . and there is no need to be philosophical about it. This will come about for the single and sufficient reason that people are so constituted that they would rather be alive than dead.1
The options for the potential transplant recipient, however, have changed. Data from recent trials of angiotensin converting enzyme inhibitors in advanced heart failure indicate that up to 90% of patients are alive a year after starting treatment.6 Furthermore, surgical alternatives to transplantation, such as implantable ventricular assist devices, are being developed. Therefore, whereas 20 years ago death was a near certainty without a transplant, and any length of survival after heart transplantation was regarded as a bonus, in the present era some patients potentially have a similar prognosis with alternative treatments.
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Younger Patients More Likely To Live A Decade Or Longer After Heart Transplant
Heart transplant patients who receive new organs before the age of 55 and get them at hospitals that perform at least nine heart transplants a year are significantly more likely than other people to survive at least 10 years after their operations, new Johns Hopkins research suggests.
Examining data from the more than 22,000 American adults who got new hearts between 1987 and 1999, researchers found that roughly half were still alive a decade after being transplanted and further analysis identified factors that appear to predict at least 10 years of life after the operations.
There are 2,000 to 2,500 heart transplants a year in the U.S. and many people die waiting, says Arman Kilic, M.D., a surgical resident at The Johns Hopkins Hospital and leader of the study published in The Annals of Thoracic Surgery. We have to be very smart about how to allocate scarce organs, and our research suggests we can predict which patients will live longer with a new heart.
Kilic and his colleagues used information collected by the United Network of Organ Sharing and compared the 9,404 heart transplant recipients who survived for 10 or more years with the 10,373 who did not. Some 3,000 were lost to follow-up.
The age of the donor was also significant. For every decade younger the donor was, the recipient was 10 percent more likely to survive long term, Kilic says.
Complications From Not Following A Lifelong Care Plan
Not following a lifelong care plan increases the risk of all heart transplant complications. Heart transplant patients are asked to closely follow their doctors’ instructions and check their own health status throughout their lives.
Lifelong health care includes taking multiple medicines on a strict schedule, watching for signs and symptoms of complications, going to all medical checkups, and making healthy lifestyle changes .
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What Happens Before A Heart Transplant
If your child needs a heart transplant, your doctor will refer you to a transplant center. There, you’ll meet the members of the transplant team, which usually includes:
The health care team will check to make sure that your child is healthy enough to have surgery and take the medicines needed after it. The team will do tests such as:
- blood tests: to determine blood type
- an echocardiogram: a test in which sound waves make an image of the heart
- an electrocardiogram : a test that records the electrical activity of the heart and can help find arrhythmias and heart muscle damage
- cardiac catheterization: a procedure in which a thin, plastic tube called a is put into a blood vessel and then threaded through to the heart so doctors can view the heart and its chambers
The doctor also might do a biopsy, removing a tiny piece of tissue from the heart to examine under a microscope.
The transplant evaluation lets the team learn as much about your child as possible. But it’s also a time for you and your child to learn about what will happen before, during, and after the transplant. The transplant team is there to provide information and support. Be sure to ask if you don’t understand something.
If the transplant team decides your child is a good candidate, the next step is to find a heart. Your child’s name will go on an organ waiting list. This list has the names of everyone who is waiting for a heart or other organs.
Who Is Considered For Heart Transplant
In general, patients with advanced HF should be considered for heart transplantation if optimal medical therapy as recommended by the ACC/AHA guidelines and cardiac resynchronization therapy have failed to improve symptoms or halt progression of the underlying pathology . Furthermore, any reversible or surgically amenable cardiac conditions should be addressed before transplantation is considered. The latter is important to guarantee the candidacy for heart transplant and reserve organs for the more needed patients. Patients who are in advanced NYHA class IV need evaluation by advanced HF teams for optimal management of multi-organ failure . Patients with severe HF have a 1 to 2 year mortality rate approaching 50%, despite advanced medical treatment . The primary indications for heart transplantation for adult patients have been nonischemic cardiomyopathy and ischemic cardiomyopathy . Other indications include: valvular heart disease , retransplantation and others .
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Indications For Heart Transplantation
The ACC/AHA guidelines include the following indications for cardiac transplantation :
- Refractory cardiogenic shock requiring intra-aortic balloon pump counterpulsation or left ventricular assist device
- Cardiogenic shock requiring continuous intravenous inotropic therapy
- Peak VO2 less than 10 mL/kg per min
- NYHA class of III or IV despite maximized medical and resynchronization therapy
- Recurrent life-threatening left ventricular arrhythmias despite an implantable cardiac defibrillator, antiarrhythmic therapy, or catheter-based ablation
- End-stage congenital HF with no evidence of pulmonary hypertension
- Refractory angina without potential medical or surgical therapeutic options.
Similarly, the European Society of Cardiology describes a series of features that must be met before consideration for heart transplant which are more specific and include, functional, structural and symptoms parameters
Q How Painful Is A Heart Transplant
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Newark Beth Israel Medical Center Heart Transplant Survival/life Expectancy
The Newark Beth Israel Heart Transplant team notes that a heart transplant is considered the gold standard treatment option for end-stage heart failure. It is only recommended when conservative treatment options fail. The worldwide heart transplant survival rate is greater than 85 percent after one year and 69 percent after 5 years for adults, which is excellent when compared to the natural course of end-stage heart failure.
The first year after surgery is the most important in regards to heart transplant survival rate. The annual death rate after the first year is only 4 percent. Recent improvements to the heart transplant survival rate can be attributed to an increased rate of survival after the first year, and specifically to improvements seen with immunosuppressant medications.
Immunosuppressant medications suppress the immune system, thereby decreasing its ability to attack foreign invaders. These medications are given to heart transplant patients to prevent the immune system from attacking the new donor heart. Immunosuppressant therapy is now tailored to the individual patient.
What If Your New Heart Fails
Heart transplants aren’t successful for everyone. Your new heart can fail for a number of reasons. Your doctor might then suggest adjusting your medications or, in more extreme cases, having another heart transplant.
If additional treatment options are limited, you might choose to stop treatment. Discussions with your heart transplant team, doctor and family should address your expectations and preferences for treatment, emergency care and end-of-life care.
©2022 Mayo Foundation for Medical Education and Research . All rights reserved.
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Nhs Organ Donor Register
If you’re interested in donating your organs after you die, you can join the NHS Organ Donor Register.
Joining the NHS Organ Donor Register is quick and simple, and will only take a few minutes of your time.
You can remove yourself from the register at any time and can specify what you’re willing to donate.
Page last reviewed: 30 April 2019 Next review due: 30 April 2022
Complications From Not Following Lifelong Health Care Plans
Not following a lifelong treatment plan increases the risk of all heart transplant complications. Heart transplant recipients are asked to closely follow their doctors’ instructions and monitor their own health status throughout their lives.
Lifelong health care includes taking multiple medicines on a strict schedule, watching for signs and symptoms of complications, keeping all medical appointments and stopping unhealthy behaviors, such as smoking.
Please feel free to download and view our booklet on heart surgery information for patients and their families .
More information is available on the Cardiovascular Center Heart Transplant page.
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How Do I Recover From A Heart Transplant
Your doctor will provide you with thorough information about recovery after a heart transplant. You will need to ensure that you listen carefully to what your doctor says and follow the instructions so that you can recover well. People who receive heart transplants are usually able to lead better lives after the surgery and can go back to their usual activities. Recovery can take six months, but it can vary from person to person.
As long as you are taking the medicines prescribed by your doctor and taking good care of yourself, as per your doctor’s recommendations, there is nothing for you to worry about. If you’re a woman who has received a heart transplant and you are planning to have a baby, then you should speak to your doctor about it. Usually, women don’t have a problem conceiving after a heart transplant, but the medications can cause complications.
What Are The Risks Of A Heart Transplant
Although heart transplant surgery is a life-saving measure, it has many risks. Careful monitoring, treatment, and regular medical care can prevent or help manage some of these risks.
The risks of having a heart transplant include:
- Failure of the donor heart
- Complications from medicines
- Problems that arise from not following a lifelong care plan after surgery
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What Problems Can Happen
One of the most common problems after transplant surgery is rejection. Rejection happens because the body doesn’t recognize the new heart and doesn’t know that it is helpful. So the immune system tries to attack it.
Medicines help to control this reaction. In a sense, they trick the body into accepting the new heart. Taking them can make your child more likely to get infections, especially in the days right after surgery. So keep your child away from sick people, and have everyone at home wash their hands well and often.
The risk of rejection is greatest in the first few weeks after transplant surgery. But the body never completely accepts the new heart. So anti-rejection medicines are taken for life.
Usually, the amount of immunosuppressants taken is reduced as the body gets used to the new heart. Rarely, the body refuses to accept the new organ and another transplant is needed.
Staying In The Hospital
The amount of time a heart transplant recipient spends in the hospital varies. Recovery often involves 1 to 2 weeks in the hospital and 3 months of monitoring by the transplant team at the heart transplant center.
Monitoring may include frequent blood tests, lung function tests, EKGs , echocardiograms, and biopsies of the heart tissue.
A heart biopsy is a standard test that can show whether your body is rejecting the new heart. This test is often done in the weeks after a transplant.
During a heart biopsy, a tiny grabbing device is inserted into a vein in the neck or groin . The device is threaded through the vein to the right atrium of the new heart to take a small tissue sample. The tissue sample is checked for signs of rejection.
While in the hospital, your health care team may suggest that you start a cardiac rehabilitation program. Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.
Cardiac rehab includes counseling, education, and exercise training to help you recover. Rehab may start with a member of the rehab team helping you sit up in a chair or take a few steps. Over time, you’ll increase your activity level.
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