What Is a Heart Transplant?

A heart transplant is a surgery to replace a failing heart with a new heart. Heart transplant surgery is a type of open-chest surgery performed by a cardiac (heart) surgeon. In this procedure, a surgeon removes a failing heart and implants a heart from a donor into your body. Most people who receive heart transplants do so to treat advanced stages of heart failure.

Getting a heart transplant is a serious surgery—and can be scary or worrisome. But knowing what to expect throughout the process can help ease your concerns and be best prepared for the procedure.

Purpose

A heart transplant is a treatment option for advanced heart failure. Your heart is a muscular pump that delivers blood throughout your body. When this pump fails and isn't able to give blood to the rest of your body, several problems can occur, including:

• Cardiomyopathy, or difficulty pumping blood
• Heart attack
• Blocked coronary arteries (the blood vessels in your heart)
• Genetic (inherited) and congenital heart disease (present from birth)
• Heart rhythm problems

A heart that is unable to effectively deliver blood to the body can cause heart failure, which can produce symptoms like:

• Shortness of breath
• Difficulty breathing when lying down
• Fatigue
• Swelling in the legs and abdomen
• Lightheadedness or dizziness

When your symptoms become severe and start to interfere with your daily life—even with treatment—your healthcare team may recommend a heart transplant. If you are a good candidate for a heart transplant, your heart surgeon will replace your heart with a healthy heart from a donor. The new heart can deliver proper amounts of blood to your organs and slowly improve your symptoms.

What Happens During a Heart Transplant

Getting a new heart can be a long process. If your healthcare team determines that you are a good candidate for a heart transplant, they will place you on the transplant list. Once they find a match for your heart, your healthcare providers will evaluate you again and prescribe medications that prevent your body from rejecting the new organ.

Once you're ready for surgery, it's worth noting that the procedure can take several hours. You can expect to stay in the hospital for up to a few weeks for recovery until your body is healthy and strong enough to return to your normal routine. After the heart transplant, you'll need regular follow-up sessions and ongoing medical care for your new heart.

Before the Heart Transplant

Before you can get a heart transplant, your healthcare team will evaluate you and perform a series of tests to determine if you are a good candidate for the procedure. This team includes specialists like heart surgeons, cardiologists (doctors who specialize in heart diseases), infectious disease specialists, nurses, and social workers.

They will perform a detailed assessment of your health, underlying health conditions, and social circumstances—such as your insurance status and whether you will have support from a caregiver—to ensure that a transplant is the best option for you. You can expect to fill out several screening questionnaires and paperwork during this process.

You will also undergo bloodwork and imaging tests to evaluate your overall health. These tests will look at the health of your other organs, such as the lungs, kidneys, liver, and blood vessels. Your healthcare team may also test you for underlying infections and cancer. They do these tests to ensure that there are no surprises and to reduce the risk of potential complications when you receive a heart transplant.

If your providers determine you're a good fit for a transplant, they will place you on a transplant list. Keep in mind: it can take several months before a good match becomes available. The transplant team evaluates the size of the heart as well as the blood type of the donor to determine if the new heart is a good match for your body. Once they find a donor heart, your providers will schedule the surgery.

During the Transplant

When the day of your surgery approaches, you will arrive at the hospital and your providers will hook you up to heart monitors and take you to the operating room. Once you arrive at the operating room, an anesthesiologist (a doctor who specializes in pain management and administers anesthesia during surgeries) will give you general anesthesia to ensure that you are asleep and comfortable during surgery.

A heart transplant is an open chest surgery—meaning your chest is cut open to access the heart. Your surgeon will place you on a heart-lung bypass machine that performs the functions of your heart and lungs during surgery. Then, they will remove your heart, implant the donor heart into your chest, and attach the major blood vessels to the new organ. Once the new heart is in place and working, your surgeon will close your chest.

After the Heart Transplant

After the surgery, you will recover in a specialized intensive care unit where your healthcare team will continuously monitor your new heart and overall health condition. You can expect to be in the hospital for up to a few weeks while you recover. Your care team will teach you how to care for your heart transplant, including taking medications, identifying signs of infection, and what to do if your body is rejecting the new heart.

Your care team will also prescribe several drug therapies, including immunosuppressant medications, which prevent your body from rejecting the new organ. You will need to follow your medication plan very closely. In the months after your heart transplant, you will have many appointments to ensure that your body is healing appropriately.

Depending on your condition, your care team may also recommend attending a cardiac rehab program that teaches you about appropriate ways to get exercise and how to care for your heart after your surgery.

Your care team will also monitor the function of the new heart by ordering regular tests. These exams include:

• Blood tests to look at immunosuppressant medication levels, blood counts, kidney function and electrolytes, and antibody levels
• Heart catheterization and biopsies to ensure your body is accepting the new organ
• Echocardiograms and cardiac MRIs may also be performed to view the heart and blood vessels

Risks and Complications

A heart transplant is a major surgery and a surgeon will only perform the procedure if you are a good candidate. To qualify as a good candidate, your healthcare team needs to expect that the heart transplant will benefit your condition and improve your symptoms. It's also important for your care team to eliminate as many potential complications as possible.

However, like any surgery, heart transplants also come with the risk of long-term complications. These include:

• Excessive bleeding, especially around the time of surgery
• Arrhythmias (abnormal heart rhythms)
• Stroke, shortly after having the surgery
• Rejection of the new heart which can happen after the transplant surgery is complete
• Coronary artery disease in the new heart (known as allograft vasculopathy), which is a late complication that can occur years after the transplant
  
• Side effects from medications, such as kidney problems, high blood pressure, diabetes, and high cholesterol
• Cancer, such as skin and blood cancers related to immune-suppressing medications that you will have to take after the procedure

Heart transplant teams must balance these potentially serious risks with the benefits of the procedure on a case-by-case basis to ensure that donor hearts, which are in limited supply, are going to people who will most benefit from the surgery.

How to Prepare

Everyone's circumstance going into a heart transplant is different, and your healthcare team can help provide individualized recommendations and answer any questions you may have. In general, you can prepare for your surgery by going to all of your scheduled visits and getting all the necessary lab and imaging tests done. It's also important to follow your medication plan closely and take medicines as prescribed.

When you receive the call that your providers found a donor organ match for you, it's essential to schedule and prepare for the surgery as soon as possible. You should plan to stay in the hospital for several weeks. Your team will already have your health information on hand, but it's a good idea to bring your test results, medical history forms, and insurance information with you.

You should also plan to bring along a caregiver or loved one to provide support during this time. It's worth noting that children may not be allowed in the hospital waiting areas, depending on specific institutional policies. If you have a child and would like for them to be present as they wait for you to get out of surgery, ensure that children are welcome at your specific hospital. Keep in mind: your loved ones will not be able to accompany you into the operating room, but can stay in the waiting room during your surgery.

Another important part of the heart transplant is figuring out the cost of the surgery. The cost of the procedure varies based on several different factors (location, your insurance policy, etc). But your healthcare team or hospital billing department should inform you about the costs prior tot he surgery. In some cases, insurance companies do cover heart transplants, but it's best to talk to your care team and insurance carrier about your financial status and options.

Outcomes of a Heart Transplant

A heart transplant is a life-saving surgery for people with advanced heart failure. Those who receive a heart transplant can go on to live a great quality of life for many years after transplant.

According to outcomes data, one year following a transplant, approximately 90% of donor heart recipients are alive. And half of people with heart transplants are still alive after 12 to 13 years. Since most people who need a heart transplant have severe symptoms that limit their daily activities, a heart transplant significantly improves their quality of life and allows them to perform their normal daily activities and work.

A Quick Review

Heart transplants are major surgeries that replace a failing heart in people with advanced heart failure with a donor heart. If you are a good candidate for a transplant and your surgery is successful, your symptoms and quality of life will improve. Getting a heart transplant comes with risks, so it's best to talk to your healthcare team about your concerns. People with a heart transplant can live for many years after their surgery and should expect to take ongoing medications after their procedure.