Heart Transplant

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Surgery Overview

A heart transplant is a procedure in which a surgeon removes a diseased heart and replaces it with a donor heart. During a heart transplant, a mechanical pump circulates blood through the body while the surgeon removes the diseased heart and replaces it with a healthy heart from a recently deceased donor.

The surgeon connects the donor heart to the major blood vessels and hooks the heart up to wires that temporarily control the heartbeat. The procedure takes several hours.

To prevent the body from rejecting the donor heart, the heart transplant team will give you medicines to lower your immune system (immunosuppressants) right after surgery. You need to take these medicines for the rest of your life to prevent rejection.

What To Expect After Surgery

After a heart transplant, the recovery process is similar to the process after other heart surgeries.

You will spend about 2 to 3 weeks in the hospital after surgery. You may have to stay longer depending on your health and if you have complications from surgery.

Your doctors will do tests (echocardiograms and biopsies) to check on your heart to make sure your body isn't rejecting it. While in hospital, you will also start a cardiac rehabilitation program.

Cardiac rehabilitation

A cardiac rehab program can help you recover from your surgery and be active again.

Your transplanted heart will respond to activity a little differently. Your heart rate will not increase like it used to. And you will have a higher resting heart rate. This is because some of the nerves that control your heart were cut during your surgery.

After a heart transplant, you must follow a strict lifestyle involving daily medicines and regular medical care, which includes regular sampling (biopsies) of the transplanted heart tissue to check for rejection.

Why It Is Done

A heart transplant is an option when the heart no longer works well (end stage heart disease). A heart transplant becomes an option when other medical treatments or surgeries cannot prolong a person's life. A person might be a candidate for a transplant when any of these conditions are true:

  • The person has end-stage heart failure from ischemic heart disease, cardiomyopathy, congenital heart disease, uncontrollable lethal heart rhythms, or other rare conditions.
  • The person has a low chance of living as long as 1 year without a heart transplant.
  • The person has no other serious medical conditions that combined with transplant would reduce their life expectancy.
  • The doctor expects that a heart transplant will increase survival and improve the person's quality of life.
  • The person doesn't smoke or has quit smoking, and is committed to not smoking for the rest of their life.
  • The person doesn't have any other active addictions.
  • Before a person is considered for an assessment and put on the waiting list, they must have quit smoking and using alcohol and other drugs for a certain time (usually at least 6 months). The transplant team will decide how long.
  • The person is committed to transplant. They'll take medicines and go to follow-up clinics and procedures for the rest of their life.

How Well It Works

In carefully selected people, a heart transplant is generally successful. About 90 to 95% of people who have a heart transplant live for at least 5 years. About 70 to 75 out of 100 live 10 years.footnote 1

Most people have a good quality of life after their transplant. They can be active, have a social life, and return to work.footnote 2

Risks

Risks from heart transplant include:

  • Anti-rejection medicines (which must be taken for the rest of your life) put you at higher risk of infections, cancers, and kidney problems.
  • Rejection of the donor heart.
    • To check for and prevent rejection, the transplant team will regularly test a sample (biopsy) of the heart tissue and also do echocardiography, electrocardiography (ECG, EKG), or blood tests.
    • If your body rejects the heart, you will receive more medicines (stronger immunosuppressants and steroids) to suppress your immune system so that it doesn't continue to reject the donor heart.
  • Infections.
  • Clogging of the arteries (atherosclerosis) that may develop in the donor heart. (This is usually a complication and is an important limiting factor that affects long-term survival.)
  • Death.

What To Think About

Candidates receive a donor heart according to the:

  • Blood Type.
  • Size Match.
  • Antibodies.
  • Date they were placed on the waiting list.
  • Severity of their heart failure symptoms.

There are limited donor hearts available.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Related Information

References

Citations

  1. Hart A, et al. (2017). OPTN/SRTR 2015 annual data report: Kidney. American Journal of Transplantation, 17(Suppl 1): 21-116. DOI: 10.1111/ajt.14124. Accessed April 26, 2017.
  2. Patel JK, Kobashigawa JA (2011). Heart transplantation. Circulation, 124(4): e132-e134.

Credits

ByHealthwise Staff
Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
E. Gregory Thompson, MD - Internal Medicine
Kathleen Romito, MD - Family Medicine
Martin J. Gabica, MD - Family Medicine
Adam Husney, MD - Family Medicine
Elizabeth T. Russo, MD - Internal Medicine
Specialist Medical ReviewerStephen Fort, MD, MRCP, FRCPC - Interventional Cardiology

Current as ofOctober 5, 2017